Provider Demographics
NPI:1093765729
Name:GAGADAM, DAYAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAYAKER
Middle Name:
Last Name:GAGADAM
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 1:11803 SOUTH FWY I-35 WEST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7005
Mailing Address - Country:US
Mailing Address - Phone:817-293-3000
Mailing Address - Fax:817-293-3291
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 208
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-3000
Practice Address - Fax:817-293-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3195207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122066703Medicaid
TX122066703Medicaid
TX00080GMedicare ID - Type Unspecified