Provider Demographics
NPI:1912219809
Name:MAYEUX, GARY P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:MAYEUX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2829 UNIVERSITY AVE SE STE 730
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3279
Mailing Address - Country:US
Mailing Address - Phone:612-863-4233
Mailing Address - Fax:612-863-4233
Practice Address - Street 1:800 E 28TH ST # MR 11112
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-6590
Practice Address - Fax:612-863-5247
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN54772207P00000X
MN54722146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10000431Medicare PIN