Provider Demographics
NPI:1831194158
Name:GWINN, ROBERT B (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:GWINN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BRENAIRD ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9023
Mailing Address - Country:US
Mailing Address - Phone:740-622-0332
Mailing Address - Fax:740-622-0335
Practice Address - Street 1:440 BROWNS LN
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2044
Practice Address - Country:US
Practice Address - Phone:740-622-0332
Practice Address - Fax:740-622-0335
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0509935Medicaid
OHA80553Medicare UPIN
OH0509935Medicaid