Provider Demographics
NPI:1356804660
Name:DUDA, GABRIEL NIKOLAUS (DO)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:NIKOLAUS
Last Name:DUDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:450 N HYATT ST
Mailing Address - Street 2:STE 202
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1433
Mailing Address - Country:US
Mailing Address - Phone:937-669-9978
Mailing Address - Fax:937-669-1266
Practice Address - Street 1:450 N HYATT ST STE 202
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1433
Practice Address - Country:US
Practice Address - Phone:937-669-9978
Practice Address - Fax:937-669-1266
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.015720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program