Provider Demographics
NPI:1770663254
Name:DEBAKEY, GARY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:DEBAKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:17376 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1114
Mailing Address - Country:US
Mailing Address - Phone:329-198-4458
Mailing Address - Fax:329-198-4468
Practice Address - Street 1:17376 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1114
Practice Address - Country:US
Practice Address - Phone:832-919-8445
Practice Address - Fax:832-919-8446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3282208VP0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035419302Medicaid
TX035419302Medicaid
TXB22175Medicare UPIN