MEDICARE: MR. DENNIS GEORGE GAY II PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102434	FL

General Provider Information

NPI Number	:	1992704670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS GEORGE GAY II PA-C

Provider Business Mailing Address
First Line	:	1603 S HIAWASSEE RD
Second Line	:	ST 115
City	:	ORLANDO
State	:	FL
Zip	:	32835-6438
Country	:	US
Telephone Number	:	407-383-0142
Fax Number	:	407-386-7247

Provider Business Practice Location Address
First Line	:	1603 S HIAWASSEE RD
Second Line	:	ST 115
City	:	ORLANDO
State	:	FL
Zip	:	32835-6438
Country	:	US
Telephone Number	:	407-383-0142
Fax Number	:	407-386-7247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/21/2007

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