Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 29997 | TX |
Y | 213EG0000X | General Practice | 29997 | TX |
NPI | 1003229477 |
---|---|
Provider Name | Dr. Michael Gerlach |
First Address | Conroe, TX 77301-1106 |
Second Address | Conroe, TX 77301-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 20/03/2016 |