Basic Information
| Provider Information | |||||||||
| NPI: | 1336135417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAHN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 WASHINGTON AVE | ||||||||
| Address2: | 390 | ||||||||
| City: | NEWPORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410711986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592914800 | ||||||||
| FaxNumber: | 8592914801 | ||||||||
| Practice Location | |||||||||
| Address1: | 12345 W BEND DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147680707 | ||||||||
| FaxNumber: | 3147680718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | R3L52 | MO | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00189882 | 01 | RAILROAD MEDICARE PIN | OTHER |