Healthcare Provider Details

I. General information

NPI: 1578585766
Provider Name (Legal Business Name): GERALD WEHR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

IV. Provider business mailing address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-1700
  • Fax: 765-496-1227
Mailing address:
  • Phone: 765-449-1700
  • Fax: 765-496-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01029009
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: