Provider Demographics
NPI:1518966118
Name:DIER, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:DIER
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:PO BOX 3635
Mailing Address - Street 2:1126 OAKWOOD DRIVE
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-7635
Mailing Address - Country:US
Mailing Address - Phone:330-569-7782
Mailing Address - Fax:330-596-7791
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4936
Practice Address - Country:US
Practice Address - Phone:330-596-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350878212085R0202X
NY2711412085R0202X
NC361722085R0202X
PAMD042743E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2714549Medicaid
NCP00152920OtherRAILROAD MEDICARE
NC89136F6Medicaid
SCN36172Medicaid
NC136F6OtherBC BS
NC2025476Medicare ID - Type Unspecified
OH4187132Medicare ID - Type Unspecified
NC2025476AMedicare ID - Type Unspecified
NCP00152920OtherRAILROAD MEDICARE