Provider Demographics
NPI:1114971892
Name:PAULSEN, GREGORY DON (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DON
Last Name:PAULSEN
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 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4100
Mailing Address - Fax:563-584-4110
Practice Address - Street 1:200 MERCY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7303
Practice Address - Country:US
Practice Address - Phone:563-589-9797
Practice Address - Fax:563-584-3227
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0057596Medicaid
IA27848Medicare ID - Type Unspecified
IA0057596Medicaid