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General NPI Number Information
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NPI Number | 1164423331
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Entity Type | Individual
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Provider Name | EDWARD JOHN GAYDOS D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 10/30/2011
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Provider Practice Location Address
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Address Line | 6559 WILSON MILLS RD BLDG D SUITE 101
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143-6402
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Country | US
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Telephone | 440-473-0010
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Fax | 440-460-2812
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Provider Business Mailing Address
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Address Line | 1346 LEDGEWOOD DR
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City | AKRON
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State | OH
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Zip | 44333-1154
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Country | US
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Telephone | 330-670-0442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34004907
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License Number State | OH
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