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General NPI Number Information
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NPI Number | 1629334099
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Entity Type | Individual
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Provider Name | GAUTAM PAUL MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 4900 HOUSTON RD
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City | FLORENCE
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State | KY
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Zip | 41042-4824
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Country | US
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Telephone | 859-301-8074
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Fax | 859-301-4945
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Provider Business Mailing Address
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Address Line | PO BOX 635283
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City | CINCINNATI
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State | OH
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Zip | 45263-5283
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Country | US
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Telephone | 859-301-8074
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Fax | 859-301-4945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48312
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | TP284
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 48312
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License Number State | KY
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