Healthcare Provider Details

I. General information

NPI: 1851754840
Provider Name (Legal Business Name): JOSHUA JAMES LYLE GAUGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST CENTER FOR EMERGENCY CARE
CINCINNATI OH
45219
US

IV. Provider business mailing address

231 ALBERT SABIN WAY MSB 1654
CINCINNATI OH
45267-0769
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-8114
  • Fax: 513-558-5791
Mailing address:
  • Phone: 513-558-8114
  • Fax: 513-558-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number# 57.028779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: