1336221530 NPI number — PAUL E GAULIN M.D.

Table of content: PAUL E GAULIN M.D. (NPI 1336221530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336221530 NPI number — PAUL E GAULIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAULIN
Provider First Name:
PAUL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336221530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5003 BUCKAROO DR UNIT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINNEMUCCA
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89445-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-420-9681
Provider Business Mailing Address Fax Number:
775-623-5085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E HASKELL ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-621-5699
Provider Business Practice Location Address Fax Number:
775-623-5085
Provider Enumeration Date:
10/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  10431 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8776383427 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".