Provider Demographics
NPI:1275523839
Name:GAHN, DAVID RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:GAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:807 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5156
Mailing Address - Country:US
Mailing Address - Phone:918-458-3100
Mailing Address - Fax:918-458-3315
Practice Address - Street 1:100 S BLISS AVE
Practice Address - Street 2:HASTINGS INDIAN MEDICAL CENTER
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2512
Practice Address - Country:US
Practice Address - Phone:918-458-3360
Practice Address - Fax:918-458-3315
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23211207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74208Medicare UPIN