Provider Demographics
NPI:1780797803
Name:KAUTH, BRIAN G (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:KAUTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:146 ASHFORD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9695
Mailing Address - Country:US
Mailing Address - Phone:828-256-2112
Mailing Address - Fax:828-256-2393
Practice Address - Street 1:2365 SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3067
Practice Address - Country:US
Practice Address - Phone:828-256-2112
Practice Address - Fax:828-256-2393
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200501082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC040EHOtherBCBS PROVIDER NUMBER
NC5901509Medicaid
NC200501082OtherLICENSE - NC
NCBK6857001OtherDEA - NC
NC5901509Medicaid
NCBK6857001OtherDEA - NC
NC040EHOtherBCBS PROVIDER NUMBER
NC2044570AMedicare Oscar/Certification