Healthcare Provider Details

I. General information

NPI: 1720151814
Provider Name (Legal Business Name): GARY W WALTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 W CEDAR ST B-3
AKRON OH
44307-2564
US

IV. Provider business mailing address

30 E BROAD ST 11TH FLOOR
COLUMBUS OH
43215-3414
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-2062
  • Fax: 330-434-0783
Mailing address:
  • Phone: 614-466-6583
  • Fax: 614-644-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-044019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: