Healthcare Provider Details

I. General information

NPI: 1083832299
Provider Name (Legal Business Name): GUMERCINDP R. JOSE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SUNSET BLVD SUITE D
STEUBENVILLE OH
43952-1380
US

IV. Provider business mailing address

1524 SUNSET BOULEVARD SUITE D
STEUBENVILLE OH
43952
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-9789
  • Fax: 740-282-7101
Mailing address:
  • Phone: 740-282-9789
  • Fax: 740-282-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35035561
License Number StateOH

VIII. Authorized Official

Name: DR. GUMERCINDO R JOSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 740-282-9789