Healthcare Provider Details

I. General information

NPI: 1780618363
Provider Name (Legal Business Name): GARY J LABIANCO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

IV. Provider business mailing address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-3533
  • Fax: 937-436-1459
Mailing address:
  • Phone: 937-436-3533
  • Fax: 937-436-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-00-2950-L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: