Provider Demographics
NPI:1801962584
Name:GERHARTER, JUDITH E (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:GERHARTER
Suffix:
Gender:F
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 60307
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8775
Mailing Address - Country:US
Mailing Address - Phone:970-683-3207
Mailing Address - Fax:970-257-2401
Practice Address - Street 1:2754 COMPASS DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8714
Practice Address - Country:US
Practice Address - Phone:970-241-2212
Practice Address - Fax:970-257-2401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPPLIED FORMedicaid
CO28600OtherLICENSE
COF14091Medicare UPIN
CO28600OtherLICENSE