Provider Demographics
NPI:1952311367
Name:GAYMON, ALFRED CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:CHARLES
Last Name:GAYMON
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 1:20 MEWS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1737
Mailing Address - Country:US
Mailing Address - Phone:973-763-8159
Mailing Address - Fax:973-763-8158
Practice Address - Street 1:4601 DALE ROAD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356
Practice Address - Country:US
Practice Address - Phone:973-699-2160
Practice Address - Fax:973-763-8158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32414207RG0100X
CAG87813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology