Healthcare Provider Details

I. General information

NPI: 1508811076
Provider Name (Legal Business Name): BRYON L GAUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HWY BLVD
SPENCER IA
51301
US

IV. Provider business mailing address

2004 HWY BLVD
SPENCER IA
51301
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-6906
  • Fax:
Mailing address:
  • Phone: 712-262-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26772
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number26772
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number26772
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number26772
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: