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General NPI Number Information
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NPI Number | 1801807755
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Entity Type | Individual
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Provider Name | GARY S DEGUZMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2115 CHAPLINE ST SUITE 306
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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 SUITE 306
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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 |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 19734
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License Number State | WV
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