Individual
GARY DALE RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 AUSTIN AVE NW, MASSILLON, OH 44646-3598
(216) 837-7200
Mailing address
7021 MILITIA HILL ST NW, CANTON, OH 44718
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34003395
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0498135
—
OH
01
—
942460636442
CARESOURCE
OH
01
—
P00332912
MEDICARE TRAVELERS RR-GA
OH
Enumeration date
06/01/2006
Last updated
01/15/2020
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