Provider Demographics
NPI:1417052457
Name:VOTH, GAYLE V (MD)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:V
Last Name:VOTH
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 1:399 W CAMPBELL RD STE 402
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3636
Mailing Address - Country:US
Mailing Address - Phone:972-783-0947
Mailing Address - Fax:972-783-0948
Practice Address - Street 1:399 W CAMPBELL RD STE 402
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3636
Practice Address - Country:US
Practice Address - Phone:972-783-0947
Practice Address - Fax:972-783-0948
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7309207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AT07OtherBCBS
TX031955001Medicaid
TX4019630OtherAETNA
TX00AT07Medicare PIN
TX00AT07OtherBCBS
TX031955001Medicaid