Provider Demographics
NPI:1043271356
Name:BABCOKE, GARY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:BABCOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26700 BROOKPARK ROAD EXT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3124
Mailing Address - Country:US
Mailing Address - Phone:800-611-6912
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:650 DICKINSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3387
Practice Address - Country:US
Practice Address - Phone:219-926-2133
Practice Address - Fax:219-926-8765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019380A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090560OtherANTHEM
IN658730BMedicare ID - Type Unspecified
IN000000090560OtherANTHEM