Provider Demographics
NPI:1144252214
Name:GAY, KENT E (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:E
Last Name:GAY
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 1:2201 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3323
Mailing Address - Country:US
Mailing Address - Phone:719-384-8181
Mailing Address - Fax:719-384-4872
Practice Address - Street 1:1100 CARSON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2751
Practice Address - Country:US
Practice Address - Phone:719-384-8181
Practice Address - Fax:719-384-4872
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01216324Medicaid
CODR21632OtherLICENSE
COP00341419OtherRAILROAD MEDICARE
COE73726Medicare UPIN
CODR21632OtherLICENSE