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General NPI Number Information
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NPI Number | 1497929152
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Entity Type | Organization
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Legal Business Name | VANCOUVER MEDICAL WEIGHT LOSS CLINIC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 10000 NE 7TH AVE SUITE 110
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City | VANCOUVER
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State | WA
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Zip | 98685-4599
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Country | US
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Telephone | 360-571-7177
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Fax | 360-843-4085
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Provider Business Mailing Address
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Address Line | 10000 NE 7TH AVE SUITE 110
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City | VANCOUVER
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State | WA
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Zip | 98685-4599
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Country | US
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Telephone | 360-571-7177
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Fax | 360-843-4085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN THOMAS GERHARD
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Credential | MD PHD
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Telephone | 360-571-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD00035811
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License Number State | WA
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