Provider Demographics
NPI:1174589618
Name:STAPLES, GLORIA V (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:V
Last Name:STAPLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 16TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1903
Mailing Address - Country:US
Mailing Address - Phone:270-707-7530
Mailing Address - Fax:270-707-7532
Practice Address - Street 1:315 W 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1903
Practice Address - Country:US
Practice Address - Phone:270-707-7530
Practice Address - Fax:270-707-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000391905OtherANTHEM BCBS
P00383175OtherRAILROAD MEDICARE
KY64118136Medicaid
KY64118136Medicaid
P00383175OtherRAILROAD MEDICARE