Provider Demographics
NPI:1124068622
Name:GAZALL, MARK RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:GAZALL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2141 N. FAIRFIELD RD
Mailing Address - Street 2:SUITE B.
Mailing Address - City:BREAVER CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2579
Mailing Address - Country:US
Mailing Address - Phone:937-458-0085
Mailing Address - Fax:937-458-0212
Practice Address - Street 1:6503 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1693
Practice Address - Country:US
Practice Address - Phone:614-810-1300
Practice Address - Fax:614-614-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34-005012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery