Provider Demographics
NPI:1801893490
Name:GAUL, GERALD R (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:GAUL
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 1:3035 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4018
Mailing Address - Country:US
Mailing Address - Phone:701-775-3151
Mailing Address - Fax:701-775-3153
Practice Address - Street 1:3035 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4018
Practice Address - Country:US
Practice Address - Phone:701-775-3151
Practice Address - Fax:701-775-3153
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5783174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16160Medicaid
NDE25355Medicare UPIN
ND0352000001Medicare NSC
NDN4767Medicare PIN