Provider Demographics
NPI:1538239173
Name:DAY, GUSTAVO HORACIO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:HORACIO
Last Name:DAY
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 738305
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-8305
Mailing Address - Country:US
Mailing Address - Phone:972-566-6764
Mailing Address - Fax:972-566-6968
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BUILDING B, SUITE416
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-6764
Practice Address - Fax:972-566-6968
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1411OtherMEDICAL LICENSE
TXP00040AM6Medicaid
TX030243201Medicaid
TX0040AMMedicare PIN