Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18967 | OH |
NPI | 1053401810 |
---|---|
Provider Name | Dr. Frederick J. Gehrke JR. |
First Address | Wickliffe, OH 44092-2670 |
Second Address | Wickliffe, OH 44092-2670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0940905 | (05) | OH |