Provider Demographics
NPI:1255308805
Name:FOULKS, GARY N (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:N
Last Name:FOULKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4121 DUTCHMANS LANE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-897-9881
Mailing Address - Fax:502-897-9824
Practice Address - Street 1:301 MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5466
Practice Address - Fax:502-852-4947
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35466207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64076128Medicaid
C83842Medicare UPIN
KY64076128Medicaid