Provider Demographics
NPI:1962460485
Name:GIDEON, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:GIDEON
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 1:139 GARAU ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1027
Mailing Address - Country:US
Mailing Address - Phone:419-369-2190
Mailing Address - Fax:
Practice Address - Street 1:139 GARAU ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1027
Practice Address - Country:US
Practice Address - Phone:419-369-2190
Practice Address - Fax:419-369-4431
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075051207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338787Medicaid
OH2338787Medicaid
H62784Medicare UPIN
OH4084651Medicare PIN