Provider Demographics
NPI:1346773066
Name:DRIVER, GARY (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DRIVER
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 1:5801 OAKBEND TRL STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3936
Mailing Address - Country:US
Mailing Address - Phone:817-377-3668
Mailing Address - Fax:
Practice Address - Street 1:5801 OAKBEND TRL STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3936
Practice Address - Country:US
Practice Address - Phone:817-377-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301287207XX0004X
390200000X
TX3093207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program