Healthcare Provider Details

I. General information

NPI: 1700636313
Provider Name (Legal Business Name): SIMON GAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST # 11AG062
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

2401 S 31ST ST # 11AG062
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberW8841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: