MEDICARE: DR. CORY ALLEN GAISER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.129570CTR	OH

General Provider Information

NPI Number	:	1306279088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY ALLEN GAISER M.D.

Provider Business Mailing Address
First Line	:	4004 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4627
Country	:	US
Telephone Number	:	513-635-7622
Fax Number	:	513-481-0013

Provider Business Practice Location Address
First Line	:	4004 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4627
Country	:	US
Telephone Number	:	513-635-7622
Fax Number	:	513-481-0013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	10/08/2020

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