Provider Demographics
NPI:1801360698
Name:NAYLOR, GARRICK GORDON
Entity Type:Individual
Prefix:
First Name:GARRICK
Middle Name:GORDON
Last Name:NAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7838 HUEBNER RD APT 8301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-6130
Mailing Address - Country:US
Mailing Address - Phone:956-336-0554
Mailing Address - Fax:
Practice Address - Street 1:2339 E EVANS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2717
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily