Provider Demographics
NPI:1497726533
Name:EARP, GARY WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:EARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 OSLER DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5407
Mailing Address - Country:US
Mailing Address - Phone:817-640-5412
Mailing Address - Fax:817-633-6630
Practice Address - Street 1:319 OSLER DR STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010
Practice Address - Country:US
Practice Address - Phone:817-640-5412
Practice Address - Fax:817-633-6630
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122124411Medicaid
TX8DA282OtherBCBS
TXD72456Medicare UPIN
TX122124411Medicaid
TXTXB140953Medicare PIN