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General NPI Number Information
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NPI Number | 1215025648
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Entity Type | Individual
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Provider Name | PAUL A GERLACH MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 2985 CORTEZ AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7554
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Country | US
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Telephone | 208-523-3373
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Fax | 208-523-8746
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Provider Business Mailing Address
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Address Line | 2985 CORTEZ AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7554
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Country | US
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Telephone | 208-523-3373
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Fax | 208-523-8746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD14220
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD14220
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License Number State | TN
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