Provider Demographics
NPI:1417130527
Name:GAULT, HENRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAY
Last Name:GAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:770 LAKE COOK RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4920
Mailing Address - Country:US
Mailing Address - Phone:847-267-0001
Mailing Address - Fax:847-267-0002
Practice Address - Street 1:770 LAKE COOK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4920
Practice Address - Country:US
Practice Address - Phone:847-267-0001
Practice Address - Fax:847-267-0002
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036464622084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry