Healthcare Provider Details

I. General information

NPI: 1427057298
Provider Name (Legal Business Name): ROBERT L GAY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

1 E ERIE ST SUITE 300
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

225 N COLUMBUS DR UNIT 6005
CHICAGO IL
60601-7910
US

V. Phone/Fax

Practice location:
  • Phone: 312-649-3939
  • Fax: 312-649-5747
Mailing address:
  • Phone: 630-853-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG184019
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036085978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: