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General NPI Number Information
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NPI Number | 1194798165
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Entity Type | Individual
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Provider Name | GARY MILLER PROULX M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 70 EAST ST
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City | METHUEN
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State | MA
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Zip | 01844-4597
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Country | US
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Telephone | 978-687-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 100 METROPOLITAN PARK DR STE 100
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City | LIVERPOOL
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State | NY
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Zip | 13088-7112
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Country | US
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Telephone | 315-870-9370
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Fax | 315-870-9364
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 206678-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD419971
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License Number State | PA
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