Provider Demographics
NPI:1235838913
Name:GEZZER, SCOTT DAVID
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:GEZZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHARDONNAY CIR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9001
Mailing Address - Country:US
Mailing Address - Phone:440-320-7800
Mailing Address - Fax:
Practice Address - Street 1:310 CHARDONNAY CIR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-9001
Practice Address - Country:US
Practice Address - Phone:440-320-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL119844172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver