Provider Demographics
NPI:1144421421
Name:GAGNON, GARRY FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:FRANCIS
Last Name:GAGNON
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 1:2403 N WASHINGTON AVE APT 219
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3767
Mailing Address - Country:US
Mailing Address - Phone:314-323-7678
Mailing Address - Fax:
Practice Address - Street 1:1717 MAIN ST
Practice Address - Street 2:SUITE 5200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4612
Practice Address - Country:US
Practice Address - Phone:214-712-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7982207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7982OtherTEXAS MEDICAL BOARD