Provider Demographics
NPI:1427090893
Name:GILCREASE, GARY LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LAWRENCE
Last Name:GILCREASE
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 1:155 CIMARRON PARK LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2800
Mailing Address - Country:US
Mailing Address - Phone:512-295-9300
Mailing Address - Fax:512-295-7300
Practice Address - Street 1:155 CIMARRON PARK LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2800
Practice Address - Country:US
Practice Address - Phone:512-295-9300
Practice Address - Fax:512-295-7300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK9069OtherTEXAS MEDICAL LICENSE
TX144784901Medicaid
TXG13553Medicare UPIN