Provider Demographics
NPI:1821318809
Name:GUCE, GARRY MACASAET (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:MACASAET
Last Name:GUCE
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 1:800 MORNING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5348
Mailing Address - Country:US
Mailing Address - Phone:646-512-1367
Mailing Address - Fax:
Practice Address - Street 1:874 ED HALL DR STE 106
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1800
Practice Address - Country:US
Practice Address - Phone:972-932-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE390200000X
TXN7094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0175196OtherTEXAS CONTROLLED SUBSTANCE NUMBER
TXN7094OtherTEXAS MEDICAL BOARD
TXTXB139895Medicare PIN
TXTXB139892Medicare PIN
TXT0175196OtherTEXAS CONTROLLED SUBSTANCE NUMBER