Provider Demographics
NPI:1588307862
Name:GAYLE, ROBERT JEREMY
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JEREMY
Last Name:GAYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S VANN ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-3622
Mailing Address - Country:US
Mailing Address - Phone:404-747-2326
Mailing Address - Fax:
Practice Address - Street 1:15 S VANN ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-3622
Practice Address - Country:US
Practice Address - Phone:404-747-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator