Provider Demographics
NPI:1588693840
Name:GWINN, JAMES S JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:GWINN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 7648
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7648
Mailing Address - Country:US
Mailing Address - Phone:800-467-2392
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-575-3113
Practice Address - Fax:270-575-3135
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19484207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64194848Medicaid
KY060008620OtherRAILROAD MEDIARE PIN
IL02002740322Medicaid
KY2152OtherKENTUCKY BLS PROVIDER
KY610976324003OtherCHAMPUS ID #
IL02002740322Medicaid
KYC64958Medicare UPIN