Organization
GARY R. HUSTON D.O., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY ROBERT HUSTON D.O, (PRESIDENT)
(440) 593-6551
Entity
Organization
Contact information
Practice address
177 WEST ST, CONNEAUT, OH 44030-2153
(440) 593-6551
(440) 593-6522
Mailing address
PO BOX 635, 177 WEST ST, CONNEAUT, OH 44030-0635
(440) 593-6551
(440) 593-6522
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
34-00-4562
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0772310
—
OH
Enumeration date
02/06/2012
Last updated
02/06/2012
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