Provider Demographics
NPI:1760479950
Name:GAYLE, RICHARD E (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GAYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 4515
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-9417
Mailing Address - Country:US
Mailing Address - Phone:573-223-4233
Mailing Address - Fax:573-223-2136
Practice Address - Street 1:RR 4 BOX 4515
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9417
Practice Address - Country:US
Practice Address - Phone:573-223-4233
Practice Address - Fax:573-223-2136
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO123050OtherHEALTHLINK
MO1113322OtherFIRST HEALTH
MO111836OtherBCBS
MO11148106OtherMULTIPLAN
MOP00035939OtherRAIL ROAD MEDICARE
MOA11605Medicare UPIN