Provider Demographics
NPI:1336135417
Name:GAHN, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:GAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 WASHINGTON AVE
Mailing Address - Street 2:390
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1986
Mailing Address - Country:US
Mailing Address - Phone:859-291-4800
Mailing Address - Fax:859-291-4801
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2182
Practice Address - Country:US
Practice Address - Phone:314-768-0707
Practice Address - Fax:314-768-0718
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3L52208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00189882OtherRAILROAD MEDICARE PIN
MOE58837Medicare UPIN
P00189882OtherRAILROAD MEDICARE PIN