1194014415 NPI number — DR. GERALD THOMAS DROCTON III M.D.

Table of content: DR. GERALD THOMAS DROCTON III M.D. (NPI 1194014415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194014415 NPI number — DR. GERALD THOMAS DROCTON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROCTON
Provider First Name:
GERALD
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194014415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5475 RINGS RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-7537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-210-1885
Provider Business Mailing Address Fax Number:
614-210-1886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5475 RINGS RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-7537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-210-1885
Provider Business Practice Location Address Fax Number:
614-210-1886
Provider Enumeration Date:
04/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35128920 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13979192 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".