Healthcare Provider Details

I. General information

NPI: 1508351685
Provider Name (Legal Business Name): SAMUEL GERHARDT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 KLUTEY PARK PLAZA DR
HENDERSON KY
42420-3347
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 270-830-6100
  • Fax: 270-826-3089
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04722
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: