Healthcare Provider Details

I. General information

NPI: 1164423331
Provider Name (Legal Business Name): EDWARD JOHN GAYDOS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6559 WILSON MILLS RD BLDG D SUITE 101
MAYFIELD VILLAGE OH
44143-6402
US

IV. Provider business mailing address

1346 LEDGEWOOD DR
AKRON OH
44333-1154
US

V. Phone/Fax

Practice location:
  • Phone: 440-473-0010
  • Fax: 440-460-2812
Mailing address:
  • Phone: 330-670-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34004907
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: