Provider Demographics
NPI:1104965284
Name:THRASHER, GARRY L (DO)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:L
Last Name:THRASHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILHAM CIR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6918
Mailing Address - Country:US
Mailing Address - Phone:330-896-1781
Mailing Address - Fax:
Practice Address - Street 1:15 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2904
Practice Address - Country:US
Practice Address - Phone:330-714-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004590208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE29696Medicare UPIN