Provider Demographics
NPI:1053393355
Name:HASH, GERRY L (DPM)
Entity type:Individual
Prefix:DR
First Name:GERRY
Middle Name:L
Last Name:HASH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:583 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5515
Mailing Address - Country:US
Mailing Address - Phone:812-339-2446
Mailing Address - Fax:812-330-9508
Practice Address - Street 1:583 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5515
Practice Address - Country:US
Practice Address - Phone:812-339-2446
Practice Address - Fax:812-330-9508
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000762A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100184980Medicaid
INM400036914Medicare PIN
INU19504Medicare UPIN