Active NPI
E. Paul Gander, M.D.
- General Practice Physician
- Racine, WI
National Provider Identifier
1669637872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 13055-20
- Practice address
- 904 State St
Racine, WI 53404-3346 - Phone
- (262) 632-2400
- Fax
- (262) 632-7988
- NPI assigned
- Jul 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 13055-20 | WI | Primary |
Addresses
Primary practice location
904 State St
Racine, WI 53404-3346
Mailing address
904 State St
Racine, WI 53404-3346
Phone (262) 632-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13055-20 | WI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1669637872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 STATE ST",
"city": "RACINE",
"state": "WI",
"postal_code": "534043346",
"telephone_number": "262-632-2400",
"fax_number": "262-632-7988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 STATE ST",
"city": "RACINE",
"state": "WI",
"postal_code": "534043346",
"telephone_number": "262-632-2400",
"fax_number": "262-632-7988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDER",
"first_name": "E.",
"middle_name": "PAUL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-28",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WI",
"license": "13055-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.