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DIETRICH A GERHARDT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Mailing address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32049
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01297
BCBS IA RGPCSC
01
03734
BCBS IA RGIC LLC
05
1189506
IA
05
2189506
IA
01
25999
BCBS OF IOWA W/ ORA
IA
01
3189506
MEDICAID OF IOWA W/ ORA
IA
01
I18223
MEDICARE W/ ORA
IA
01
K51233
MEDICARE ORA ILLINOIS
IA
01
P000275282
RR MDC RGPCSC
Enumeration date
03/28/2006
Last updated
04/12/2021
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