Healthcare Provider Details

I. General information

NPI: 1386616316
Provider Name (Legal Business Name): WILLIAM G GERLACH DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HAMPTON VILLAGE PLZ SUITE 274
SAINT LOUIS MO
63109-2128
US

IV. Provider business mailing address

16 HAMPTON VILLAGE PLZ SUITE 274
SAINT LOUIS MO
63109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-5436
  • Fax: 314-352-0749
Mailing address:
  • Phone: 314-352-5436
  • Fax: 314-352-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000454
License Number StateMO

VIII. Authorized Official

Name: DR. WILLIAM GERLACH
Title or Position: OWNER OF PRACTICE
Credential: MD
Phone: 314-352-5436