Provider Demographics
NPI:1669770509
Name:SHAY, GERALD WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WALTER
Last Name:SHAY
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 1:9017 EARLY AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1581
Mailing Address - Country:US
Mailing Address - Phone:160-843-7177
Mailing Address - Fax:
Practice Address - Street 1:9017 EARLY AUTUMN RD
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1581
Practice Address - Country:US
Practice Address - Phone:160-843-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16845207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology