Healthcare Provider Details

I. General information

NPI: 1760479950
Provider Name (Legal Business Name): RICHARD E GAYLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

IV. Provider business mailing address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-4233
  • Fax: 573-223-2136
Mailing address:
  • Phone: 573-223-4233
  • Fax: 573-223-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31158
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: