Provider Demographics
NPI:1992879514
Name:GINGRICH, GARY A (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:GINGRICH
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 1:1805 E 19TH ST
Mailing Address - Street 2:PO BOX 1520
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3365
Mailing Address - Country:US
Mailing Address - Phone:541-296-2201
Mailing Address - Fax:541-296-1237
Practice Address - Street 1:1805 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3365
Practice Address - Country:US
Practice Address - Phone:541-296-2201
Practice Address - Fax:541-296-1237
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14322208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC97271Medicare UPIN
OR132809Medicare ID - Type UnspecifiedMEDICARE NUMBER