Provider Demographics
NPI:1386816288
Name:GAZAILLE, ROLAND E III (DO)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:E
Last Name:GAZAILLE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:635 FAR HILLS AVE
Mailing Address - Street 2:APT #5
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3852
Mailing Address - Country:US
Mailing Address - Phone:937-564-3269
Mailing Address - Fax:
Practice Address - Street 1:2799 WEST GRAND BLVD A-4 DIAGNOSTIC RADIOLOGY
Practice Address - Street 2:HENRY FORD HEALTH SYSTEM
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:937-564-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0090152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology