Healthcare Provider Details

I. General information

NPI: 1669416046
Provider Name (Legal Business Name): ANTHONY T TAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 BUTTONWOOD DR SUITE 200
COLUMBIA MO
65201-3721
US

IV. Provider business mailing address

29 NW 1ST LN
LAMAR MO
64759-8105
US

V. Phone/Fax

Practice location:
  • Phone: 417-689-4080
  • Fax:
Mailing address:
  • Phone: 417-681-5248
  • Fax: 417-681-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2003007573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: