1336135417 NPI number — RICHARD S. GAHN MD

Table of content: RICHARD S. GAHN MD (NPI 1336135417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336135417 NPI number — RICHARD S. GAHN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAHN
Provider First Name:
RICHARD
Provider Middle Name:
S.
Provider Name Prefix Text:
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:
1336135417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 WASHINGTON AVE
Provider Second Line Business Mailing Address:
390
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41071-1986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-291-4800
Provider Business Mailing Address Fax Number:
859-291-4801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12345 W BEND DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-0707
Provider Business Practice Location Address Fax Number:
314-768-0718
Provider Enumeration Date:
09/23/2005

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: 208VP0014X , with the licence number:  R3L52 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00189882 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".




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