Healthcare Provider Details

I. General information

NPI: 1891735460
Provider Name (Legal Business Name): HOUNEINE JOHN GASHASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 LINCOLN ST E
CANTON OH
44707-2769
US

IV. Provider business mailing address

2725 LINCOLN ST E
CANTON OH
44707-2769
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-2000
  • Fax: 330-454-6184
Mailing address:
  • Phone: 330-454-2000
  • Fax: 330-454-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40702
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: