Provider Demographics
NPI:1801807755
Name:DEGUZMAN, GARY S (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-234-1817
Mailing Address - Fax:304-234-8448
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-234-1817
Practice Address - Fax:304-234-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV19734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0300027000Medicaid
OH2160281Medicaid
WVG14433Medicare UPIN
WV0887261Medicare ID - Type Unspecified