Healthcare Provider Details

I. General information

NPI: 1760464267
Provider Name (Legal Business Name): WILLIAM GERLACH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/20/2011
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: