Provider Demographics
NPI:1770672792
Name:GAGE, EDWARD S
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:GAGE
Suffix:
Gender:M
Credentials:
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Mailing Address - Street 1:335 PLEASANT POINT DR
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1164
Mailing Address - Country:US
Mailing Address - Phone:803-699-9073
Mailing Address - Fax:803-764-2361
Practice Address - Street 1:650 JOEL DRIVE
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-798-8372
Practice Address - Fax:270-956-0180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-05-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN