Provider Demographics
NPI:1699061085
Name:GAUL, MAREN KELLY NESS (DO)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:KELLY NESS
Last Name:GAUL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MAREN
Other - Middle Name:KELLY
Other - Last Name:NESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-755-8107
Mailing Address - Fax:
Practice Address - Street 1:4150 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6022
Practice Address - Country:US
Practice Address - Phone:605-755-5700
Practice Address - Fax:605-755-5701
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12230207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology