Basic Information
| Provider Information | |||||||||
| NPI: | 1912982422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 12TH ST | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413865070 | ||||||||
| FaxNumber: | 5413867190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 12TH ST | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413865070 | ||||||||
| FaxNumber: | 5413867190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 12/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD17103 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11004 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 024211 | 05 | OR | MEDICAID | K5099 03 | 01 | PACIFIC SOURCE | OTHER | 8126997 | 05 | WA | MEDICAID | 080028718 | 01 | RAILROAD MEDICARE | OTHER | 1256728 | 01 | UNITED HEALTHCARE | OTHER | 55852 | 01 | WA | DEPT OF LABOR AND INDUSTR | OTHER |