Provider Demographics
NPI:1578745469
Name:DOUGLAS L GAKER MD INC
Entity Type:Organization
Organization Name:DOUGLAS L GAKER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-423-0739
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:513-705-0071
Mailing Address - Fax:513-705-0075
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:513-705-0071
Practice Address - Fax:513-705-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE51782Medicare UPIN
OH9931141Medicare PIN