Provider Demographics
NPI:1518964378
Name:GAY, JASON B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:B
Last Name:GAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 CLAYTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2930
Mailing Address - Country:US
Mailing Address - Phone:314-442-4452
Mailing Address - Fax:866-216-3928
Practice Address - Street 1:10435 CLAYTON RD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2930
Practice Address - Country:US
Practice Address - Phone:314-442-4452
Practice Address - Fax:866-216-3928
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001030167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970022879OtherRR MEDICARE
MO153860OtherBCBS
MO472282OtherHEALTHLINK
MO472282OtherHEALTHLINK