Healthcare Provider Details

I. General information

NPI: 1932656386
Provider Name (Legal Business Name): TODD GAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14425 S BITTERBRUSH LN
DRAPER UT
84020-9501
US

IV. Provider business mailing address

890 E 1100 S
OREM UT
84097-6629
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-7000
  • Fax:
Mailing address:
  • Phone: 801-602-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10074125-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: