Koltis, Gordon Gary
Koltis, Gordon Gary is an individual health care provider with primary practice located at 801 W H Smith Blvd , Greenville NC 27834-3764. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Radiation Oncology, Allopathic & Osteopathic Physicians / Therapeutic Radiology. Allopathic & Osteopathic Physicians / Radiation Oncology is his primary health care specialty. Koltis, Gordon Gary can be contacted via phone (252) 329-0025.Contact Information
Primary practice address
801 W H Smith Blvd
Greenville NC 27834-3764
Phone: (252) 329-0025
Fax: (252) 329-0325
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | 33390 | North Carolina |
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | G86259 | California |
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | ME-0051462 | Florida |
| Allopathic & Osteopathic Physicians / Therapeutic Radiology | 2085R0203X | MD-035235-E | Pennsylvania |
| Allopathic & Osteopathic Physicians / Therapeutic Radiology | 2085R0203X | 247085 | Wisconsin |
| Allopathic & Osteopathic Physicians / Therapeutic Radiology | 2085R0203X | MD-018789 | Tennessee |
Profile Details
| NPI number | 1508860545 |
|---|---|
| LBN Legal business name | Koltis, Gordon Gary |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2005 |
| Last updated | Sep 10th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508860545 | NPPES |
| North Carolina | Other | 49898 | BCBS |
| North Carolina | Other | 24-00059 | BCBS |
| North Carolina | Other | 9421363-001 | BCBS |
| North Carolina | Other | P00612668 | BCBS |
| North Carolina | MEDICAID | 8949898 | BCBS |
| North Carolina | Other | 30013692 | BCBS |
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