Healthcare Provider Details

I. General information

NPI: 1962460485
Provider Name (Legal Business Name): JAMES A GIDEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 GARAU ST
BLUFFTON OH
45817-1027
US

IV. Provider business mailing address

139 GARAU ST
BLUFFTON OH
45817-1027
US

V. Phone/Fax

Practice location:
  • Phone: 419-369-2190
  • Fax: 419-369-4431
Mailing address:
  • Phone: 419-369-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.075051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: