Provider Demographics
NPI:1306823018
Name:MASHIGIAN, GARY CHARLES (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHARLES
Last Name:MASHIGIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 N JOSEY LN
Mailing Address - Street 2:STE 206
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4631
Mailing Address - Country:US
Mailing Address - Phone:972-625-7009
Mailing Address - Fax:
Practice Address - Street 1:4333 N JOSEY LN
Practice Address - Street 2:STE 206
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4631
Practice Address - Country:US
Practice Address - Phone:972-939-1757
Practice Address - Fax:972-939-1682
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0948213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86981SOtherBCBS PROVIDER NUMBER
TX130992404Medicaid
TX87071KMedicare ID - Type Unspecified
TX130992404Medicaid