Provider Demographics
NPI:1235634502
Name:GAGE, ROY JR
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:GAGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7729 S MINGO RD APT A807
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3323
Mailing Address - Country:US
Mailing Address - Phone:918-713-1160
Mailing Address - Fax:
Practice Address - Street 1:7729 S MINGO RD APT A807
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3323
Practice Address - Country:US
Practice Address - Phone:918-713-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator