Provider Demographics
NPI:1013908185
Name:NOWORATZKY, GARY L (PA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:NOWORATZKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 RITA LN
Mailing Address - Street 2:STE. 113
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4573
Mailing Address - Country:US
Mailing Address - Phone:817-468-9200
Mailing Address - Fax:817-468-9222
Practice Address - Street 1:501 RITA LN
Practice Address - Street 2:STE. 113
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4573
Practice Address - Country:US
Practice Address - Phone:817-468-9200
Practice Address - Fax:817-468-9222
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83N781Medicare ID - Type Unspecified
S63806Medicare UPIN
TX83N781Medicare PIN