Healthcare Provider Details

I. General information

NPI: 1306849823
Provider Name (Legal Business Name): RICK W GEBHART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CORPORATE CENTER DR
VANDALIA OH
45377-1167
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-619-0050
  • Fax: 937-619-0069
Mailing address:
  • Phone: 937-619-0050
  • Fax: 937-619-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: