1922051036 NPI number — THOMAS PAUL GONSOULIN MD

Table of content: THOMAS PAUL GONSOULIN MD (NPI 1922051036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922051036 NPI number — THOMAS PAUL GONSOULIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONSOULIN
Provider First Name:
THOMAS
Provider Middle Name:
PAUL
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:
1922051036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80129-2342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-795-5587
Provider Business Mailing Address Fax Number:
303-795-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W COUNTY LINE RD
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80129-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-795-5587
Provider Business Practice Location Address Fax Number:
303-795-3404
Provider Enumeration Date:
05/18/2006

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: 207Y00000X , with the licence number:  44032 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48757276 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97427055 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: C810211 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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