Provider Demographics
NPI:1922051036
Name:GONSOULIN, THOMAS PAUL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:GONSOULIN
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 1:200 W COUNTY LINE RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2342
Mailing Address - Country:US
Mailing Address - Phone:303-795-5587
Mailing Address - Fax:303-795-3404
Practice Address - Street 1:200 W COUNTY LINE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-795-5587
Practice Address - Fax:303-795-3404
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44032207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48757276Medicaid
CO97427055OtherMEDICAID GROUP NUMBER
COC810211OtherMEDICARE GROUP NUMBER
COC810211OtherMEDICARE GROUP NUMBER
CO97427055OtherMEDICAID GROUP NUMBER
LAB63810Medicare UPIN