Provider Demographics
NPI:1821041328
Name:DONOVITZ, GARY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEVEN
Last Name:DONOVITZ
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 1:4224 PARK SPRINGS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016
Mailing Address - Country:US
Mailing Address - Phone:817-467-7474
Mailing Address - Fax:817-468-8643
Practice Address - Street 1:4224 PARK SPRINGS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-467-7474
Practice Address - Fax:817-468-8643
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099828801Medicaid
TXB22324Medicare UPIN