Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | C40108 | CA |
NPI | 1043382104 |
---|---|
Provider Name | Ted Wayne Gay |
First Address | Vista, CA 92084-6055 |
Second Address | Vista, CA 92084-6055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C40180 | (05) | CA |
A88163 | (02) |