Healthcare Provider Details

I. General information

NPI: 1164117966
Provider Name (Legal Business Name): HUNTER LAWRENCE GAZDA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE FL 4
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

395 W 12TH AVE FL 4
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-0768
  • Fax:
Mailing address:
  • Phone: 614-366-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number58.033899
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151016208
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: