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General NPI Number Information
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NPI Number | 1396027892
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Entity Type | Organization
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Legal Business Name | GERALD M. POHOST, MD, INC.
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 1505 WILSON TER SUITE 150
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City | GLENDALE
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State | CA
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Zip | 91206-4071
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Country | US
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Telephone | 818-409-3501
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Fax | 818-956-7680
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Provider Business Mailing Address
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Address Line | 2200 N MAYFAIR RD SUITE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-2252
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Country | US
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Telephone | 414-258-9511
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Fax | 414-607-3946
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD M. POHOST
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Credential | MD
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Telephone | 818-409-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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