Provider Demographics
NPI:1740208677
Name:DEGUIA, GABRIEL T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:T
Last Name:DEGUIA
Suffix:JR
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 1:7029 JUNIPERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2558
Mailing Address - Country:US
Mailing Address - Phone:513-984-1114
Mailing Address - Fax:513-984-3814
Practice Address - Street 1:7029 JUNIPERVIEW LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2558
Practice Address - Country:US
Practice Address - Phone:513-984-1114
Practice Address - Fax:513-984-3814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0217208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0550747Medicaid
OH000000010977OtherANTHEM BC./BS
OHB77524Medicare UPIN
OH0550747Medicaid