Gary F Jeznach, MD
Individual provider Active NPI Family Medicine Physician · Sturbridge, MA
NPI 1124013305 · NPPES record last updated Jun 18, 2008
Key facts
- NPI
- 1124013305
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 49792 (MA)
- Practice address
- 118 Main St
Sturbridge, MA 01566-1533 - Phone
- (508) 347-5755
- Fax
- (508) 347-5702
- NPI assigned
- Sep 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050405000761 | MA | Practitioner - Family Practice | 0042267734 | Practice locations: Sturbridge, MA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49792 | MA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49792 | MA | Yes |
Addresses
Primary practice location
118 Main St
Sturbridge, MA 01566-1533
Mailing address
118 Main St
Sturbridge, MA 01566-1533
Phone (508) 347-5755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6172873 | Medicaid | MA |
Other providers in Sturbridge, MA
- Kevin Hughes
- In Line Chiropractic, LLC
- Bianca Jackson
- Michael Charles Jedrzynski
- Jet Dental of Massachusetts
- Larry A Johnson
- Kristina Joy
- Dnyanesh Pranay Kanake
- Stephanie Elizabeth Keaney
- James L Kiely
All providers in Sturbridge, MA · Family Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.