Healthcare Provider Details

I. General information

NPI: 1093960320
Provider Name (Legal Business Name): AFTER-HOURS INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 LAKEVIEW DR
BEAVERCREEK OH
45431-3695
US

IV. Provider business mailing address

PO BOX 2026
FAIRBORN OH
45324-8026
US

V. Phone/Fax

Practice location:
  • Phone: 937-751-7477
  • Fax:
Mailing address:
  • Phone: 937-751-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35050604
License Number StateOH

VIII. Authorized Official

Name: MR. RAYMOND H GAIER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 937-751-7477