Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34767 | KY |
NPI | 1982628871 |
---|---|
Provider Name | Dr. Richard G. Gautraud |
First Address | Fort Thomas, KY 41075-1793 |
Second Address | Fort Thomas, KY 41075-1793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 13/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0968976 | (05) | OH |
201047720 | (05) | IN |
64938509 | (05) | KY |
F17003 | (02) |