Provider Demographics
NPI:1023066222
Name:ROUAN, GREGORY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:WAYNE
Last Name:ROUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:STE 310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-3700
Mailing Address - Country:US
Mailing Address - Phone:513-245-3444
Mailing Address - Fax:513-245-3449
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:STE 6000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-7880
Practice Address - Fax:513-475-7327
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-046436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110111852OtherRAIL ROAD MEDICARE
KY64773947Medicaid
OH0537146Medicaid
IN200070040Medicaid
TN4047838Medicaid
IN200070040Medicaid
TN4047838Medicaid