Provider Demographics
NPI:1639734056
Name:GERDES, ZACHARY (PHD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GERDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 FITZGERALD RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2633
Mailing Address - Country:US
Mailing Address - Phone:206-503-1818
Mailing Address - Fax:
Practice Address - Street 1:300 S TWINING ST, BLDG 760
Practice Address - Street 2:MAXWELL AIR FORCE BASE 42D MEDICAL GROUP
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6219
Practice Address - Country:US
Practice Address - Phone:334-953-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist