Provider Demographics
NPI:1386611465
Name:GATTIS, WILLIAM EVERETT (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EVERETT
Last Name:GATTIS
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 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2208
Mailing Address - Country:US
Mailing Address - Phone:970-641-1456
Mailing Address - Fax:970-641-4461
Practice Address - Street 1:707 N IOWA ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2229
Practice Address - Country:US
Practice Address - Phone:970-642-8413
Practice Address - Fax:970-641-9017
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40233207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13778862Medicaid
H28558Medicare UPIN
COC300586Medicare PIN
COP00671032Medicare PIN
CO465698Medicare ID - Type Unspecified