Provider Demographics
NPI:1003159047
Name:DALEY, GILROY LANE SR (MD)
Entity Type:Individual
Prefix:DR
First Name:GILROY
Middle Name:LANE
Last Name:DALEY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 MARIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40516
Mailing Address - Country:US
Mailing Address - Phone:859-293-2429
Mailing Address - Fax:859-293-2429
Practice Address - Street 1:3111 MARIA DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40516
Practice Address - Country:US
Practice Address - Phone:859-293-2429
Practice Address - Fax:859-293-2429
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD78182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX484987YVYMMedicare PIN