Provider Demographics
NPI:1033189022
Name:GAY, CHARLES T (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:GAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:T
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D P A
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 396
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3713
Mailing Address - Country:US
Mailing Address - Phone:210-614-3737
Mailing Address - Fax:210-614-3147
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 396
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3713
Practice Address - Country:US
Practice Address - Phone:210-614-3737
Practice Address - Fax:210-614-3147
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG81262084N0402X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100825910AMedicaid
TX129615408Medicaid
TX8AJ972OtherBCBS OF TEXAS
TX129615407Medicaid
TX129615408Medicaid
TXTXB103620Medicare PIN
TX8AJ972OtherBCBS OF TEXAS