Provider Demographics
NPI:1477554988
Name:GAYID, MAMDOOH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMDOOH
Middle Name:
Last Name:GAYID
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 1:242 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5202
Mailing Address - Country:US
Mailing Address - Phone:909-793-3311
Mailing Address - Fax:909-793-0241
Practice Address - Street 1:242 CAJON ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5202
Practice Address - Country:US
Practice Address - Phone:909-793-3311
Practice Address - Fax:909-793-0241
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85467207R00000X
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900648Medicaid
NC2039372Medicare ID - Type UnspecifiedPROVIDER NUMBER
NCI27248Medicare UPIN