Provider Demographics
NPI:1225008469
Name:GAY, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 WEST PALM
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1300
Mailing Address - Country:US
Mailing Address - Phone:979-865-8484
Mailing Address - Fax:979-865-8686
Practice Address - Street 1:235 WEST PALM
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1300
Practice Address - Country:US
Practice Address - Phone:979-865-8484
Practice Address - Fax:979-865-8686
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127938202Medicaid
TX127938202Medicaid
TX127938202Medicaid
TX8K4130Medicare PIN