| Organization Name: | GARY R. HUSTON D.O., INC |
| NPI Number: | 1114299104 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY ROBERT HUSTON (PRESIDENT) |
| Mailing Address: | 177 West St Conneaut |
| State: | OH US |
| Postal Code: | 440302153 |
| Phone Number: | 4405936551 |
| Fax Number: | 4405936522 |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 02/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 34-00-4562 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |