Provider Demographics
NPI:1306849823
Name:GEBHART, RICK W (DO)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:W
Last Name:GEBHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-619-0050
Mailing Address - Fax:937-619-0069
Practice Address - Street 1:505 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1167
Practice Address - Country:US
Practice Address - Phone:937-619-0050
Practice Address - Fax:937-619-0069
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23334OtherNATIONWIDE HEALTH PLAN
OHD0578203OtherHUMANA/CHOICECARE
OH0122721OtherUNITED HEALTHCARE
OH080191701OtherRAILROAD MEDICARE
OH0938249Medicaid
OH2192769OtherAETNA
OH302622980900OtherOHIO BWC
OH000000227856OtherANTHEM
OH147240004OtherCARESOURCE
OH34005782OtherMEDICAL LICENSE
OH147240004OtherCARESOURCE
OH0938249Medicaid