Provider Demographics
NPI:1912937723
Name:GAY, AMANDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:S
Last Name:GAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:S
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:142 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4152
Mailing Address - Country:US
Mailing Address - Phone:503-263-1500
Mailing Address - Fax:503-263-1505
Practice Address - Street 1:142 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4152
Practice Address - Country:US
Practice Address - Phone:503-263-1500
Practice Address - Fax:503-263-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286642Medicaid
OR286642Medicaid
ORR134336Medicare PIN