Healthcare Provider Details

I. General information

NPI: 1528059409
Provider Name (Legal Business Name): GALEN G. DUROSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N 1ST ST
DENNISON OH
44621-1003
US

IV. Provider business mailing address

819 N 1ST ST
DENNISON OH
44621-1003
US

V. Phone/Fax

Practice location:
  • Phone: 740-922-0000
  • Fax: 740-922-8042
Mailing address:
  • Phone: 740-922-0000
  • Fax: 740-922-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.076116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: