Healthcare Provider Details

I. General information

NPI: 1679597793
Provider Name (Legal Business Name): GEORGE L GAY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S VINE ST
BELLEVILLE WI
53508-9179
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-3384
  • Fax: 608-437-4542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18529-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: