Provider Demographics
NPI:1700803780
Name:BEDEL, GARY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:BEDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:333 CONOVER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1900
Mailing Address - Country:US
Mailing Address - Phone:937-746-3088
Mailing Address - Fax:937-746-8752
Practice Address - Street 1:333 CONOVER DR
Practice Address - Street 2:SUITE E
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1900
Practice Address - Country:US
Practice Address - Phone:937-746-3088
Practice Address - Fax:937-746-8752
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000233331OtherANTHEM BC/BS
0109269OtherUNITED HEALTHCARE
OH0923326Medicaid
OHE92036Medicare UPIN
000000233331OtherANTHEM BC/BS