Vancouver Medical Weight Loss Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD00035811 Issued in WA

Legal business name

VANCOUVER MEDICAL WEIGHT LOSS CLINIC

Practice address

10000 NE 7TH Ave
Suite 110
Vancouver, WA 98685-4599

Phone

(360) 571-7177

Fax

(360) 843-4085

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Thomas Gerhard, MD PHD

Title

President

Phone

(360) 571-7177

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1497929152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 NE 7TH AVE",
            "address_2": "SUITE 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986854599",
            "telephone_number": "360-571-7177",
            "fax_number": "360-843-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 NE 7TH AVE",
            "address_2": "SUITE 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986854599",
            "telephone_number": "360-571-7177",
            "fax_number": "360-843-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCOUVER MEDICAL WEIGHT LOSS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "GERHARD",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-571-7177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD  PHD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "MD00035811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1113943",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.