1164427456 NPI number — DR. GUY FRANK GEHLING MD

Table of content: DR. GUY FRANK GEHLING MD (NPI 1164427456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164427456 NPI number — DR. GUY FRANK GEHLING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEHLING
Provider First Name:
GUY
Provider Middle Name:
FRANK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1164427456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1663
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-529-1284
Provider Business Mailing Address Fax Number:
509-522-1798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W POPLAR ST
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-1030
Provider Business Practice Location Address Fax Number:
509-529-6066
Provider Enumeration Date:
06/14/2005

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: 207T00000X , with the licence number:  MD00019781 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140000208 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0243184 . This is a "WA LNI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 877672 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GE5927 . This is a "REGENCE WA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 266114 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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