Individual
MR. GARY ROBERT HUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
177 WEST ST, CONNEAUT, OH 44030
(440) 593-6551
(440) 593-6522
Mailing address
177 WEST ST, CONNEAUT, OH 44030
(440) 593-6551
(440) 593-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34004562
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0772310
—
OH
Enumeration date
08/08/2006
Last updated
07/08/2007
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