Basic Information
| Provider Information | |||||||||
| NPI: | 1962607598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERHARDT | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6420 CLAYTON TD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101016987 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2010004185 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1962607598 | 05 | MP | MEDICAID | 036125041 2 | 05 | IL | MEDICAID |