Provider Demographics
NPI:1710200506
Name:W.GORDY DAY,M.D.LLC
Entity Type:Organization
Organization Name:W.GORDY DAY,M.D.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GORDY
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-223-6347
Mailing Address - Street 1:3001 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5129
Mailing Address - Country:US
Mailing Address - Phone:325-223-6347
Mailing Address - Fax:325-223-6377
Practice Address - Street 1:3001 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5129
Practice Address - Country:US
Practice Address - Phone:325-223-6347
Practice Address - Fax:325-223-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3277173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC72157Medicare UPIN