Provider Demographics
NPI:1053335737
Name:PAUL GERARD
Entity type:Organization
Organization Name:PAUL GERARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-769-5579
Mailing Address - Street 1:100 HELMWOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2975
Mailing Address - Country:US
Mailing Address - Phone:270-769-5579
Mailing Address - Fax:270-765-7975
Practice Address - Street 1:100 HELMWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2975
Practice Address - Country:US
Practice Address - Phone:270-769-5579
Practice Address - Fax:270-765-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9728Medicare ID - Type Unspecified
9728Medicare PIN