Individual
DR. JAMES S GWINN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 KENTUCKY AVE, SUITE 301, PADUCAH, KY 42003-3817
(270) 575-3113
(270) 575-3135
Mailing address
POST OFFICE BOX 7648, PADUCAH, KY 42002-7648
(800) 467-2392
(812) 471-6650
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
19484
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02002740322
—
IL
01
—
060008620
RAILROAD MEDIARE PIN
KY
01
—
2152
KENTUCKY BLS PROVIDER
KY
01
—
610976324003
CHAMPUS ID #
KY
05
—
64194848
—
KY
Enumeration date
06/30/2006
Last updated
09/12/2011
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