Provider Demographics
NPI:1134182975
Name:GURKIN, MYSTAN ASHLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MYSTAN
Middle Name:ASHLEY
Last Name:GURKIN
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 HIGHWAY 290 W
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5432
Practice Address - Country:US
Practice Address - Phone:979-421-2000
Practice Address - Fax:979-421-9678
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7163208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159869004Medicaid
TXP0062953OtherRAILROAD GBA - RAILROAD MEDICARE
TXP01090493OtherRAILROAD MEDICARE PTAN
TX8DE529OtherBC/BS #
TXMDK7163TXOtherWORKERS COMPENSATION
TX159869001Medicaid
TX8J1711OtherBC/BX TX#
TXP0062953OtherRAILROAD GBA - RAILROAD MEDICARE
TXH90216Medicare UPIN
TXP01090493OtherRAILROAD MEDICARE PTAN