Provider Demographics
NPI:1740377175
Name:STRONG, GARY B (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:STRONG
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1108 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4430
Practice Address - Country:US
Practice Address - Phone:682-885-3255
Practice Address - Fax:817-338-9563
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2279208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82V083OtherBCBS-TX
TX135098509Medicaid
E77041Medicare UPIN
TX8L25974Medicare PIN
TX1837485OtherPHCS PIN
TX1640328OtherCCN PIN
TX4400674OtherAETNA PIN
TX1640328OtherFIRSTHEALTH PIN
E77041Medicare UPIN
TX138412507Medicaid
TX124054OtherSUPERIOR PIN
TX00U87ZOtherBCBSTX GRP PIN
TX2818270OtherCIGNA PIN
TX132344OtherUHC PIN
TX10028676OtherAMERIGROUP PIN
TX135098501Medicaid
TX124959100OtherFIRSTCARE PIN
TX82V083OtherBCBSTX IND PIN
TX82V083Medicare PIN