Provider Demographics
NPI:1104658392
Name:GERIG, LEON G
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:G
Last Name:GERIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3752
Mailing Address - Country:US
Mailing Address - Phone:330-904-2664
Mailing Address - Fax:
Practice Address - Street 1:702 23RD ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3752
Practice Address - Country:US
Practice Address - Phone:330-904-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health