Provider Demographics
NPI:1407875859
Name:OCHS, GARY DORRELL (PAC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DORRELL
Last Name:OCHS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6411
Mailing Address - Country:US
Mailing Address - Phone:910-798-2212
Mailing Address - Fax:
Practice Address - Street 1:706 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6411
Practice Address - Country:US
Practice Address - Phone:910-798-2212
Practice Address - Fax:910-798-2242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101719207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85548OtherNCBCBS
NC8985548Medicaid
NC393898OtherMAMSI
NC970022487OtherMEDICARE RAILROAD
NC2753841AMedicare ID - Type Unspecified
NC970022487OtherMEDICARE RAILROAD