Provider Demographics
NPI:1376545673
Name:GAKER, DOUGLAS L (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:GAKER
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 1:112 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4023
Mailing Address - Country:US
Mailing Address - Phone:513-423-0739
Mailing Address - Fax:513-423-2265
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4023
Practice Address - Country:US
Practice Address - Phone:513-423-0739
Practice Address - Fax:513-423-2265
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059236208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795135Medicaid
OHE51872Medicare UPIN
OHH075570Medicare PIN