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General NPI Number Information
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NPI Number | 1396176442
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Entity Type | Individual
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Provider Name | DEREK GORSUCH
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Gender | Male
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Dates
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Enumeration Date | 11/27/2013
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 2405 N COLUMBUS ST STE 140
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City | LANCASTER
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State | OH
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Zip | 43130-8189
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Country | US
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Telephone | 740-652-9334
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Fax |
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Provider Business Mailing Address
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Address Line | 140 E WILLOW DR
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City | ZANESVILLE
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State | OH
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Zip | 43701-1249
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Country | US
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Telephone |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 02964
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License Number State | OH
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