Provider Demographics
NPI:1962479162
Name:GERHART, CRAIG SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:SCOTT
Last Name:GERHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-964-7965
Mailing Address - Fax:515-964-8937
Practice Address - Street 1:215 SW WALNUT
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-964-7965
Practice Address - Fax:515-964-8937
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149310Medicaid
14931Medicare ID - Type Unspecified
A01283Medicare UPIN