Provider Demographics
NPI:1417060351
Name:GURGUIS, GEORGE NAZMY (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NAZMY
Last Name:GURGUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:NM
Other - Last Name:GURGUIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4500 S. LANCASTER RD.
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216
Mailing Address - Country:US
Mailing Address - Phone:214-857-0912
Mailing Address - Fax:214-857-0827
Practice Address - Street 1:4500 S. LANCASTER RD.
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0912
Practice Address - Fax:214-857-0827
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9085283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB140085Medicare PIN