MEDICARE: LEONARD DAVID GAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	R4A96	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01201857	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245288760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD DAVID GAUM MD

Provider Business Mailing Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-8850
Fax Number	:	314-569-3846

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-8850
Fax Number	:	314-569-3846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/03/2014

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Directions to “ LEONARD DAVID GAUM MD” Practice Location

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