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NPI Code Detail

MEDICARE: DR. PAUL DOUGLAS GLEASON II M.D.

MEDICARE: DR. PAUL DOUGLAS GLEASON II M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0106XOrthopaedic Hand Surgery Physician01047902AIN
2207XS0106XOrthopaedic Hand Surgery PhysicianL6400TX
3207XS0106XOrthopaedic Hand Surgery Physician35.124984OH

General Provider Information

NPI Number : 1558357509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL DOUGLAS GLEASON II M.D.
Provider Business Mailing Address
First Line : 4160 LITTLE YORK RD STE 10
Second Line :
City : DAYTON
State : OH
Zip : 45414-5803
Country : US
Telephone Number : 937-415-9137
Fax Number :
Provider Business Practice Location Address
First Line : 4160 LITTLE YORK RD STE 10
Second Line :
City : DAYTON
State : OH
Zip : 45414-5803
Country : US
Telephone Number : 937-257-9416
Fax Number : 937-656-1235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 08/28/2019

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