Provider Demographics
NPI:1467569673
Name:GAUL, BRADLEY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAY
Last Name:GAUL
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:KS
Mailing Address - Zip Code:66087-0547
Mailing Address - Country:US
Mailing Address - Phone:785-985-2211
Mailing Address - Fax:785-985-2444
Practice Address - Street 1:207 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:KS
Practice Address - Zip Code:66087-0547
Practice Address - Country:US
Practice Address - Phone:785-985-2211
Practice Address - Fax:785-985-2444
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7G07207Q00000X
KS421035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10001202700OtherCHP
MO202430245Medicaid
2161714OtherAETNA
MO10001202700OtherCHP
MO16564066OtherBLUE SHIELD KC
KS058187OtherBLUE CROSS KS
KS060698OtherBLUE CROSS KS
KS100147340DMedicaid
KS100147340EMedicaid
MOP00714641OtherRR MEDICARE
MO16564066OtherBLUE SHIELD KC
B91277Medicare UPIN
MO202430245Medicaid