MEDICARE: PAUL GERHARDS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7444	OR

General Provider Information

NPI Number	:	1366513160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL GERHARDS LMT

Provider Business Mailing Address
First Line	:	11306 NE 34TH CT
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98686-4376
Country	:	US
Telephone Number	:	503-313-8366
Fax Number	:	866-859-9183

Provider Business Practice Location Address
First Line	:	9860 SW HALL BLVD
Second Line	:	SUITE C-2
City	:	TIGARD
State	:	OR
Zip	:	97223-8896
Country	:	US
Telephone Number	:	503-313-8366
Fax Number	:	866-859-9183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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