Individual
GILBERT M MAMAUAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
346 BEECHWOOD DR, LONDON, KY 40744-5403
(859) 227-7666
(606) 864-4774
Mailing address
PO BOX 370, LONDON, KY 40743-0370
(859) 227-7666
(606) 864-4774
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
31417
KY
207R00000X
Internal Medicine Physician
31417
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000525342
ANTHEM BCBS
KY
01
—
000000526857
ANTHEM BCBS
KY
05
—
6431417200
—
KY
Enumeration date
05/05/2006
Last updated
03/10/2023
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