Provider Demographics
NPI:1760464267
Name:GERLACH, WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GERLACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HAMPTON VILLAGE PLZ
Mailing Address - Street 2:SUITE 274
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2128
Mailing Address - Country:US
Mailing Address - Phone:314-352-5436
Mailing Address - Fax:
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ
Practice Address - Street 2:SUITE 274
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2128
Practice Address - Country:US
Practice Address - Phone:314-352-5436
Practice Address - Fax:314-352-0749
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000454213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO301521407Medicaid
MOP00276729OtherRR MEDICARE PIN
MO211294743Medicare PIN
MO301521407Medicaid