Provider Demographics
NPI:1003242298
Name:GANTNER, THOMAS J (PAC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:GANTNER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9142
Mailing Address - Country:US
Mailing Address - Phone:740-788-9220
Mailing Address - Fax:740-522-8070
Practice Address - Street 1:2750 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9142
Practice Address - Country:US
Practice Address - Phone:740-788-9220
Practice Address - Fax:740-522-8070
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-003782363A00000X
OH50.003782363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant