Healthcare Provider Details

I. General information

NPI: 1831194158
Provider Name (Legal Business Name): ROBERT B GWINN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BROWNS LN
COSHOCTON OH
43812-2044
US

IV. Provider business mailing address

223 BRENAIRD ST
COSHOCTON OH
43812-9023
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0332
  • Fax: 740-622-0335
Mailing address:
  • Phone: 740-622-0332
  • Fax: 740-622-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: