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General NPI Number Information
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NPI Number | 1285829101
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Entity Type | Individual
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Provider Name | ARLAN MARCUS GUSTILO-ASHBY M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 7740 WASHNGTON VLG DR STE 160
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City | CENTERVILLE
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State | OH
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Zip | 45459-4056
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Country | US
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Telephone | 937-436-9825
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Fax | 937-433-6508
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Provider Business Mailing Address
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Address Line | 7740 WASHINGTON VILLAGE DR STE 160
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City | CENTERVILLE
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State | OH
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Zip | 45459-4056
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Country | US
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Telephone | 937-436-9825
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Fax | 937-433-6508
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 35-084685
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35-084685
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 35084685
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License Number State | OH
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