Provider Demographics
NPI:1659464949
Name:GERLACH, DAVID CAMPBELL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CAMPBELL
Last Name:GERLACH
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 1:800 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9204
Mailing Address - Country:US
Mailing Address - Phone:336-780-0372
Mailing Address - Fax:
Practice Address - Street 1:800 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9204
Practice Address - Country:US
Practice Address - Phone:913-367-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-50238207R00000X
NC9500591207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF69551Medicare UPIN