Healthcare Provider Details

I. General information

NPI: 1285829101
Provider Name (Legal Business Name): ARLAN MARCUS GUSTILO-ASHBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ARLAN MARCUS GUSTILO- ASHBY M.D.

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 WASHNGTON VLG DR STE 160
CENTERVILLE OH
45459-4056
US

IV. Provider business mailing address

7740 WASHINGTON VILLAGE DR STE 160
CENTERVILLE OH
45459-4056
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-9825
  • Fax: 937-433-6508
Mailing address:
  • Phone: 937-436-9825
  • Fax: 937-433-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35-084685
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-084685
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number35084685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: