Provider Demographics
NPI:1699071480
Name:GAY, WILLIAM JEROME (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEROME
Last Name:GAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 HWY 11 NORTH
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311
Mailing Address - Country:US
Mailing Address - Phone:606-464-0061
Mailing Address - Fax:606-464-0420
Practice Address - Street 1:1027 HWY 11 NORTH
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311
Practice Address - Country:US
Practice Address - Phone:606-464-0061
Practice Address - Fax:606-464-0420
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2133207Q00000X
KY03453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160250Medicaid
KY7100160250Medicaid