Healthcare Provider Details

I. General information

NPI: 1588693840
Provider Name (Legal Business Name): JAMES S GWINN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KENTUCKY AVE SUITE 301
PADUCAH KY
42003-3817
US

IV. Provider business mailing address

POST OFFICE BOX 7648
PADUCAH KY
42002-7648
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-3113
  • Fax: 270-575-3135
Mailing address:
  • Phone: 800-467-2392
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number19484
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: