Provider Demographics
NPI:1710290085
Name:GAULT, WILLIAM B
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:GAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:KS
Mailing Address - Zip Code:67074-9662
Mailing Address - Country:US
Mailing Address - Phone:316-745-5061
Mailing Address - Fax:316-745-5061
Practice Address - Street 1:311 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:KS
Practice Address - Zip Code:67074-9662
Practice Address - Country:US
Practice Address - Phone:316-745-5061
Practice Address - Fax:316-745-5061
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator