Healthcare Provider Details

I. General information

NPI: 1831183821
Provider Name (Legal Business Name): ROBERT E GEHRINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

IV. Provider business mailing address

1071 BRIGHTON DR
MENASHA WI
54952-2935
US

V. Phone/Fax

Practice location:
  • Phone: 920-445-7226
  • Fax:
Mailing address:
  • Phone: 920-725-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23564
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: