MEDICARE: GARY L LEROY MD

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	207Q00000X	Family Medicine Physician	35.059093	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588603724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L LEROY MD

Provider Business Mailing Address
First Line	:	2132 E 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1930
Country	:	US
Telephone Number	:	937-208-6850
Fax Number	:	937-208-6866

Provider Business Practice Location Address
First Line	:	2132 E 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1930
Country	:	US
Telephone Number	:	937-208-6850
Fax Number	:	937-208-6866

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	11/12/2007

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Directions to “ GARY L LEROY MD” Practice Location

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