Healthcare Provider Details

I. General information

NPI: 1104809771
Provider Name (Legal Business Name): RICHARD L GUMMER II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER RD SUITE 1080
COLUMBUS OH
43214-3912
US

IV. Provider business mailing address

3555 OLENTANGY RIVER RD SUITE 1080
COLUMBUS OH
43214-3912
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-8164
  • Fax: 614-268-8406
Mailing address:
  • Phone: 614-268-8164
  • Fax: 614-268-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.083168
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.083168
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.083168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: