Healthcare Provider Details

I. General information

NPI: 1215726997
Provider Name (Legal Business Name): DELANEY RYLEY GAGE CAULEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 S 2ND ST
LOUISVILLE KY
40203-2211
US

IV. Provider business mailing address

963 S 2ND ST
LOUISVILLE KY
40203-2211
US

V. Phone/Fax

Practice location:
  • Phone: 502-977-9007
  • Fax:
Mailing address:
  • Phone: 502-977-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: