Healthcare Provider Details

I. General information

NPI: 1740208677
Provider Name (Legal Business Name): GABRIEL T DEGUIA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7029 JUNIPERVIEW LN
CINCINNATI OH
45243-2558
US

IV. Provider business mailing address

7029 JUNIPERVIEW LN
CINCINNATI OH
45243-2558
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1114
  • Fax: 513-984-3814
Mailing address:
  • Phone: 513-984-1114
  • Fax: 513-984-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35-04-0217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: