Provider Demographics
NPI:1528059409
Name:DUROSE, GALEN G (MD)
Entity type:Individual
Prefix:DR
First Name:GALEN
Middle Name:G
Last Name:DUROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1003
Mailing Address - Country:US
Mailing Address - Phone:740-922-0000
Mailing Address - Fax:740-922-0025
Practice Address - Street 1:819 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1003
Practice Address - Country:US
Practice Address - Phone:740-922-0000
Practice Address - Fax:740-922-8042
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2205509Medicaid
OHH27509Medicare UPIN
OHDU4036451Medicare ID - Type Unspecified