Provider Demographics
NPI:1083765226
Name:DILDY, GARY ANDREW III (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANDREW
Last Name:DILDY
Suffix:III
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 1:6651 MAIN STREET
Mailing Address - Street 2:SUITE F1040
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-826-7375
Mailing Address - Fax:832-825-7948
Practice Address - Street 1:6651 MAIN STREET
Practice Address - Street 2:SUITE F1040
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-826-7375
Practice Address - Fax:832-825-7948
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184517-1205207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT184517-8905OtherMEDICAL LICENSE
ID003671100Medicaid
ID1136171Medicare PIN
F00528Medicare UPIN
ID003671100Medicaid
UT005788404Medicare PIN
UT000068947Medicare PIN