Provider Demographics
NPI:1447239371
Name:KING, GAIL S (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:S
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1670
Mailing Address - Country:US
Mailing Address - Phone:970-925-8005
Mailing Address - Fax:970-920-1652
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:#103
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1648
Practice Address - Country:US
Practice Address - Phone:970-925-8005
Practice Address - Fax:970-920-1652
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82700532Medicaid
KI671206OtherBLUE CROSS
G08175Medicare UPIN
CO82700532Medicaid