Provider Demographics
NPI:1043382104
Name:GAY, TED WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:WAYNE
Last Name:GAY
Suffix:
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 1:122 ESCONDIDO AVENUE
Mailing Address - Street 2:STE 101
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6055
Mailing Address - Country:US
Mailing Address - Phone:760-806-9263
Mailing Address - Fax:760-806-9264
Practice Address - Street 1:122 ESCONDIDO AVENUE
Practice Address - Street 2:STE 101
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6055
Practice Address - Country:US
Practice Address - Phone:760-806-9263
Practice Address - Fax:760-806-9264
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40108207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C40180Medicaid
A88163Medicare UPIN
CA00C40180Medicaid