Provider Demographics
NPI:1669460564
Name:PAULS, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:PAULS
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 1:1133 COLLEGE AVE
Mailing Address - Street 2:BLDG E-220
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2777
Mailing Address - Country:US
Mailing Address - Phone:785-539-5341
Mailing Address - Fax:785-539-1238
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BLDG E-220
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2777
Practice Address - Country:US
Practice Address - Phone:785-539-5341
Practice Address - Fax:785-539-1238
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422829208600000X
KS04-22829208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100141150AMedicaid
KS014486Medicare ID - Type Unspecified
KS100141150AMedicaid
KS003821Medicare PIN
KSF47808Medicare UPIN