Provider Demographics
NPI:1447757539
Name:DASCANIO, GAYLAN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:GAYLAN
Middle Name:JEAN
Last Name:DASCANIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 TAWAKONI DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4806
Mailing Address - Country:US
Mailing Address - Phone:805-245-1010
Mailing Address - Fax:
Practice Address - Street 1:4100 ALPHA RD STE 650
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4381
Practice Address - Country:US
Practice Address - Phone:972-243-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics