Healthcare Provider Details

I. General information

NPI: 1336121672
Provider Name (Legal Business Name): GARY R AHNQUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S 3RD ST SUITE A
DANVILLE KY
40422-2016
US

IV. Provider business mailing address

333 S 3RD ST SUITE A
DANVILLE KY
40422-2016
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-7712
  • Fax: 859-236-7246
Mailing address:
  • Phone: 859-236-7712
  • Fax: 859-236-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19001
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: