Basic Information
| Provider Information | |||||||||
| NPI: | 1588693840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GWINN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | POST OFFICE BOX 7648 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420027648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004672392 | ||||||||
| FaxNumber: | 8124716650 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 KENTUCKY AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705753113 | ||||||||
| FaxNumber: | 2705753135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 19484 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 64194848 | 05 | KY | MEDICAID | 060008620 | 01 | KY | RAILROAD MEDIARE PIN | OTHER | 02002740322 | 05 | IL | MEDICAID | 2152 | 01 | KY | KENTUCKY BLS PROVIDER | OTHER | 610976324003 | 01 | KY | CHAMPUS ID # | OTHER |