Provider Demographics
NPI:1386738458
Name:GAYAGOY, JOSEPH D (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:GAYAGOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 S FAIRMONT AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5100
Mailing Address - Country:US
Mailing Address - Phone:209-366-2031
Mailing Address - Fax:209-366-2032
Practice Address - Street 1:999 S FAIRMONT AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5100
Practice Address - Country:US
Practice Address - Phone:209-366-2060
Practice Address - Fax:209-366-2032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA56352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563520Medicaid
CA00A563522Medicare PIN
CAG85397Medicare UPIN