Provider Demographics
NPI:1629062690
Name:WILLIAMS, GARY B (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:WILLIAMS
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 1:75 ARCH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-253-5335
Mailing Address - Fax:330-253-6233
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-253-5335
Practice Address - Fax:330-253-6233
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI0420562OtherMEDICARE ID
OH0312861Medicaid
OH0312861Medicaid