Individual
GORDON GARY KOLTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
519 DEMOCRACY PL FL 2, APEX, NC 27523-5793
(252) 916-1778
(919) 362-0717
Mailing address
PO BOX 725, APEX, NC 27502-0725
(252) 916-1778
(919) 362-0717
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
33390
NC
2085R0001X
Radiation Oncology Physician
G86259
CA
2085R0001X
Radiation Oncology Physician
ME-0051462
FL
2085R0203X
Therapeutic Radiology Physician
247085
WI
2085R0203X
Therapeutic Radiology Physician
MD-018789
TN
2085R0203X
Therapeutic Radiology Physician
MD-035235-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24-00059
UNITED HEALTHCARE
NC
01
—
30013692
RAILROAD MEDICARE
NC
01
—
49898
BCBS
NC
05
—
8949898
—
NC
01
—
9421363-001
CIGNA
NC
01
—
P00612668
RAILROAD MEDICARE PTAN
NC
Enumeration date
06/08/2005
Last updated
01/15/2026
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