Provider Demographics
NPI:1780668558
Name:TAY, HOWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:P
Last Name:TAY
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:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7106
Practice Address - Country:US
Practice Address - Phone:602-337-8500
Practice Address - Fax:602-337-8151
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24054208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351396Medicaid
AZG25733Medicare UPIN
AZZ188142Medicare PIN