Provider Demographics
NPI:1760553754
Name:ENGLAND, GARY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:ENGLAND
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 1:2603 KENTUCKY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-442-5102
Mailing Address - Fax:270-442-5108
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-442-5102
Practice Address - Fax:270-442-5108
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207053Medicaid
C74162Medicare UPIN
1303301Medicare ID - Type Unspecified