Individual
PAUL E GANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 N THEATRE DRIVE, MARION, IN 46952-1700
(765) 662-4142
(419) 866-5453
Mailing address
830 NORTH BALDWIN AVE, MARION, IN 46952-2542
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
01059985A
IN
2085R0202X
Diagnostic Radiology Physician
01059985A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000519329
ANTHEM
IN
05
—
200509010
—
IN
01
—
P00414325
MEDICARE RAILROAD
IN
Enumeration date
05/23/2006
Last updated
09/06/2012
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