Provider Demographics
NPI:1780618363
Name:LABIANCO, GARY J (DPM)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:LABIANCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2206
Mailing Address - Country:US
Mailing Address - Phone:937-436-3533
Mailing Address - Fax:937-436-1459
Practice Address - Street 1:5676 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2206
Practice Address - Country:US
Practice Address - Phone:937-436-3533
Practice Address - Fax:937-436-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2950-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306707Medicaid
OH0306707Medicaid
OHLA0813396Medicare ID - Type Unspecified