Provider Demographics
NPI:1336121672
Name:AHNQUIST, GARY R (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:AHNQUIST
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 1:333 S 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2016
Mailing Address - Country:US
Mailing Address - Phone:859-236-7712
Mailing Address - Fax:859-236-7246
Practice Address - Street 1:333 S 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2016
Practice Address - Country:US
Practice Address - Phone:859-236-7712
Practice Address - Fax:859-236-7246
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY07-00064OtherUNITED HEALTH CARE
KYAA7697040OtherHEALTHWISE
KY160033441OtherMEDICARE RR
KY19001OtherLICENSE
KY64190010Medicaid
KY000000046066OtherBCBS
KY5731704OtherAETNA
KY07-00064OtherUNITED HEALTH CARE
KYC73918Medicare UPIN