Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A67283 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A67283 | CA |
NPI | 1003905191 |
---|---|
Provider Name | Michael B Gerhardt |
First Address | Santa Monica, CA 90404-2139 |
Second Address | Santa Monica, CA 90404-2139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 10/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H70553 | (02) | CA |