Provider Demographics
NPI:1962445916
Name:CROLL, GARY ALVIN (MD)
Entity Type:Individual
Prefix:PROF
First Name:GARY
Middle Name:ALVIN
Last Name:CROLL
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 1:9330 POPPY DR STE 403
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4625
Mailing Address - Country:US
Mailing Address - Phone:214-328-4389
Mailing Address - Fax:214-328-4085
Practice Address - Street 1:9330 POPPY DR STE 403
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4625
Practice Address - Country:US
Practice Address - Phone:214-328-4389
Practice Address - Fax:214-328-4085
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081535901Medicaid
TX131574905Medicaid
TX131574901Medicaid
TX110116872OtherRR MEDICARE (D.I.S)
TX81G570OtherBCBS
TX110006252OtherRR MEDICARE
TX110116872OtherRR MEDICARE (D.I.S)
TX081535901Medicaid
TXC14898Medicare UPIN
TX83G902Medicare PIN