Provider Demographics
NPI:1710981196
Name:GASS, GEORGE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAVID
Last Name:GASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2018
Mailing Address - Country:US
Mailing Address - Phone:903-592-6901
Mailing Address - Fax:903-595-2571
Practice Address - Street 1:912 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2018
Practice Address - Country:US
Practice Address - Phone:903-592-6901
Practice Address - Fax:903-595-2571
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1088207RC0200X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094796203Medicaid
TX115734903Medicaid
TX115734903Medicaid
TX81G447Medicare ID - Type Unspecified