Provider Demographics
NPI:1144273053
Name:GAGUCAS, RAUL J (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:J
Last Name:GAGUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5148
Mailing Address - Fax:740-446-5488
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5148
Practice Address - Fax:740-446-5488
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17773207ZP0102X
OH35-07-2887207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007412OtherANTHEM BCBS
OH000000191258OtherUNISON MEDICAID
OH2031376OtherMOLINA MEDICAID
OH2031376Medicaid
OH310917085139OtherCARESOURCE MEDICAID
220020393OtherRR MEDICARE
WV0102973000Medicaid
WV0832603Medicare PIN
OH0832605Medicare PIN
OH2031376OtherMOLINA MEDICAID