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General NPI Number Information
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NPI Number | 1609006329
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Entity Type | Organization
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Legal Business Name | GARY JOSEPH DO, INC.
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 4700 ROCKSIDE RD SUITE 535
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2155
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Country | US
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Telephone | 866-972-5265
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Fax | 866-972-5301
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Provider Business Mailing Address
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Address Line | 4700 ROCKSIDE RD SUITE 535
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2155
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Country | US
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Telephone | 866-972-5265
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Fax | 866-972-5301
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GARY JOSEPH
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Credential | D.O.
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Telephone | 866-972-5265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34.006110
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License Number State | OH
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