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General NPI Number Information
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NPI Number | 1871534636
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Entity Type | Individual
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Provider Name | GERALD M. POHOST MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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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 TERRACE SUITE 150
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City | GLENDALE
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State | CA
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Zip | 61206-4007
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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 NORTH MAYFAIR ROAD 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 |
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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 | G86422
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | G84622
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License Number State | CA
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