Provider Demographics
NPI:1265422356
Name:TAMEZ, GARY LEE (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:TAMEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3884 MONITOR RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9298
Practice Address - Country:US
Practice Address - Phone:989-671-2000
Practice Address - Fax:989-671-4000
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0983119OtherHEALTHPLUS
1001095OtherMCLAREN HEALTH PLAN
381908328OtherHCAP
116626OtherGREAT LAKES HEALTH PLAN
MI2832651OtherMOLINA HEALTH CARE
381908328OtherTRICARE
MI1265422356Medicaid
381908328OtherPPOM
381908328OtherFIRST HEALTH
MI080G310660OtherBLUE CARE NETWORK OF MICHIGAN
MI119OtherCOMMUNITY CHOICE
381908328OtherUNITED HEALTH CARE
MI080G310660OtherBCBS
MI080G310660OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
1001095OtherHEALTH ADVANTAGE PPO
4584510OtherAETNA
4584510OtherAETNA
MI0983119OtherHEALTHPLUS
MI1265422356Medicaid