Provider Demographics
NPI:1942235536
Name:TSE, GLADYS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:
Last Name:TSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 TEXAS HEALTH TRL STE 250
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6850
Mailing Address - Country:US
Mailing Address - Phone:817-306-5630
Mailing Address - Fax:817-306-5631
Practice Address - Street 1:10840 TEXAS HEALTH TRL STE 250
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6850
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:817-306-5631
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005008377207V00000X
TXN9656207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285304601Medicaid
TX285304602Medicaid
MO207331208Medicaid
P00365742Medicare PIN
IL$$$$$$$$$Medicaid
I35135Medicare UPIN