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Organization

MANSFIELD FAMILY PRACTICE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAYMOND JOHN GARDNER M.D. (PARTNER)
(419) 524-2212
Entity
Organization

Contact information

Practice address
248 BLYMYER AVE, MANSFIELD, OH 44903-2306
(419) 524-2212
(419) 524-9040
Mailing address
248 BLYMYER AVE, MANSFIELD, OH 44903-2306
(419) 524-2212
(419) 524-9040

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2261234
OH
Enumeration date
07/07/2005
Last updated
07/21/2022
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