Provider Demographics
NPI:1548452287
Name:CRAIG S GERHART MD PC
Entity type:Organization
Organization Name:CRAIG S GERHART MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-964-7965
Mailing Address - Street 1:215 SW WALNUT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:515-964-7965
Mailing Address - Fax:515-964-8937
Practice Address - Street 1:215 SW WALNUT
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-964-7965
Practice Address - Fax:515-964-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02946207Q00000X
IA20200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7722Medicare PIN