Provider Demographics
NPI:1073597225
Name:COULON, GERARD (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:COULON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5625
Mailing Address - Country:US
Mailing Address - Phone:785-354-0517
Mailing Address - Fax:785-478-1508
Practice Address - Street 1:6725 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5625
Practice Address - Country:US
Practice Address - Phone:785-354-0517
Practice Address - Fax:785-478-1508
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-19528208D00000X, 207P00000X, 208D00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100138780CMedicaid
KSC67168Medicare UPIN
KS068002012Medicare PIN
KS068002012Medicare PIN