Individual
DR. HENRY JAY GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
770 LAKE COOK RD, SUITE 250, DEERFIELD, IL 60015-4920
(847) 267-0001
(847) 267-0002
Mailing address
770 LAKE COOK RD, SUITE 250, DEERFIELD, IL 60015-4920
(847) 267-0001
(847) 267-0002
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
03646462
IL
Other
Enumeration date
12/11/2007
Last updated
12/11/2007
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