Healthcare Provider Details

I. General information

NPI: 1003027202
Provider Name (Legal Business Name): PAUL GASTON DEL VALLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

860 E BROAD ST STE I
ELYRIA OH
44035-6542
US

V. Phone/Fax

Practice location:
  • Phone: 740-348-4318
  • Fax: 740-348-4217
Mailing address:
  • Phone: 740-348-4318
  • Fax: 740-348-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.089044
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82167
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number35.089044
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number41045
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number82167
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD41045
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: