Basic Information
| Provider Information | |||||||||
| NPI: | 1346773066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRIVER | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 OAKBEND TRL STE 140 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761323936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173773668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5801 OAKBEND TRL STE 140 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761323936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173773668 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 0103301287 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XX0004X | 3093 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.