Provider Demographics
NPI:1275840969
Name:GOLE, GERARD JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:JOSEPH
Last Name:GOLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 SHAFFER ST
Mailing Address - Street 2:STE #1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1633
Mailing Address - Country:US
Mailing Address - Phone:269-381-3963
Mailing Address - Fax:
Practice Address - Street 1:1722 SHAFFER ST
Practice Address - Street 2:STE #1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1633
Practice Address - Country:US
Practice Address - Phone:269-381-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant