Provider Demographics
NPI:1013901347
Name:GERIG, WINSTON C (MD)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:C
Last Name:GERIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5232
Mailing Address - Country:US
Mailing Address - Phone:574-535-9100
Mailing Address - Fax:574-535-1020
Practice Address - Street 1:2006 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5232
Practice Address - Country:US
Practice Address - Phone:574-535-9100
Practice Address - Fax:574-535-1020
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01037332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354570Medicaid
IN100354570Medicaid
164560AMedicare ID - Type Unspecified