Provider Demographics
NPI:1952395048
Name:SPANGLER, GARY W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:SPANGLER
Suffix:JR
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 1:646 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3904
Mailing Address - Country:US
Mailing Address - Phone:281-218-7200
Mailing Address - Fax:281-218-7203
Practice Address - Street 1:646 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3904
Practice Address - Country:US
Practice Address - Phone:281-218-7200
Practice Address - Fax:281-218-7203
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158488008Medicaid
TXP00027747OtherRAILROAD MEDICARE
TXH84241Medicare UPIN
TX158488008Medicaid