Individual
GARY J WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 TRIPLETT ST, OWENSBORO, KY 42303-3163
(270) 686-8500
(270) 685-5467
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 686-8500
(270) 685-5467
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23029
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000550297
CHS INC ANTHEM PIN #
KY
05
—
6423029500
—
KY
Enumeration date
07/26/2005
Last updated
05/14/2019
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