Provider Demographics
NPI:1083832299
Name:GUMERCINDP R. JOSE, M.D., INC.
Entity Type:Organization
Organization Name:GUMERCINDP R. JOSE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUMERCINDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-282-9789
Mailing Address - Street 1:1524 SUNSET BOULEVARD
Mailing Address - Street 2:SUITE D
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:740-282-9789
Mailing Address - Fax:740-282-7101
Practice Address - Street 1:1524 SUNSET BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:740-282-9789
Practice Address - Fax:740-282-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035561208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223805Medicaid
OH0223805Medicaid
OH0390301Medicare ID - Type Unspecified