Provider Demographics
NPI:1073518262
Name:GAGEL, JAMES SCOTT (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SCOTT
Last Name:GAGEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50097770OtherPASSPORT - NOTC/NOS
KY95005617Medicaid
KY000000958829OtherANTHEM - NOTC/NOS
KY0512313Medicare ID - Type UnspecifiedMEDICARE GROUP # 5123
KY50097770OtherPASSPORT - NOTC/NOS
KY95005617Medicaid