Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35.095799 | OH |
N | 208600000X | Surgeon | 35.095799 | OH |
Y | 2086S0102X | Surgical Critical Care | 35.095799 | OH |
N | 2086S0127X | Trauma Surgeon | 35.095799 | OH |
NPI | 1033198742 |
---|---|
Provider Name | Travis Wade Gerlach |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45219-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |