Individual
GAUTAM PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4900 HOUSTON RD, FLORENCE, KY 41042-4824
(859) 301-8074
(859) 301-4945
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-8074
(859) 301-4945
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48312
KY
208M00000X
Hospitalist Physician
Primary
48312
KY
208M00000X
Hospitalist Physician
TP284
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128628
—
OH
05
—
201323420
—
IN
05
—
7100349130
—
KY
01
—
P01502961
RR MEDICARE
KY
Enumeration date
04/10/2012
Last updated
02/06/2024
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