Basic Information
| Provider Information | |||||||||
| NPI: | 1336121672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHNQUIST | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 S 3RD ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404222016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592367712 | ||||||||
| FaxNumber: | 8592367246 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S 3RD ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404222016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592367712 | ||||||||
| FaxNumber: | 8592367246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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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 | 207V00000X | 19001 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 07-00064 | 01 | KY | UNITED HEALTH CARE | OTHER | AA7697040 | 01 | KY | HEALTHWISE | OTHER | 160033441 | 01 | KY | MEDICARE RR | OTHER | 19001 | 01 | KY | LICENSE | OTHER | 64190010 | 05 | KY | MEDICAID | 000000046066 | 01 | KY | BCBS | OTHER | 5731704 | 01 | KY | AETNA | OTHER |