Physician Compare National (NPI:1134302433)

HEALTHCARE PROVIDER: EARL ANTHONY GAGE MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1134302433
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880753854
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120813000610
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GAGE
	Individual professional last name
Provider First Name	EARL
	Individual professional first name
Provider Middle Name	ANTHONY
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	621 S NEW BALLAS RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 281A
	Group Practice or individual's line 2 address
City	SAINT LOUIS
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	631418256
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260020
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL ST LOUIS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y