MEDICARE: DR. JAMES M. GERHARD DDS

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	122300000X	Dentist	019.018592	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1568467702	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1437310687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M. GERHARD DDS

Provider Business Mailing Address
First Line	:	230 E 8TH ST
Second Line	:	SUITE #5
City	:	LOCKPORT
State	:	IL
Zip	:	60441-3081
Country	:	US
Telephone Number	:	815-838-6102
Fax Number	:	815-838-6281

Provider Business Practice Location Address
First Line	:	230 E 8TH ST
Second Line	:	SUITE #5
City	:	LOCKPORT
State	:	IL
Zip	:	60441-3081
Country	:	US
Telephone Number	:	815-838-6102
Fax Number	:	815-838-6281

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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