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General NPI Number Information
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NPI Number | 1659586428
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Entity Type | Organization
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Legal Business Name | GARY S DEGUZMAN, M.D., INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2115 CHAPLINE ST SUITE306
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City | WHEELING
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State | WV
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Zip | 26003-3859
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Country | US
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Telephone | 304-234-1817
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Fax | 304-234-8448
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Provider Business Mailing Address
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Address Line | 2115 CHAPLINE ST SUITE306
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City | WHEELING
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State | WV
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Zip | 26003-3859
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Country | US
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Telephone | 304-234-1817
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Fax | 304-234-8448
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY S DEGUZMAN
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Credential | M.D.
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Telephone | 304-234-1817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19734
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License Number State | WV
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