Provider Demographics
NPI:1073510855
Name:FRANTZ, GARY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:FRANTZ
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 1:248 BLYMYER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2306
Mailing Address - Country:US
Mailing Address - Phone:419-524-2212
Mailing Address - Fax:419-524-9040
Practice Address - Street 1:248 BLYMYER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2306
Practice Address - Country:US
Practice Address - Phone:419-524-2212
Practice Address - Fax:419-524-9040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450793Medicaid
OHFR0478414Medicare PIN
OH0450793Medicaid