MEDICARE: ETHAN DAVID GAGER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AP139837	TX
2	363LF0000X	Family Nurse Practitioner	907598	MS
3	363LF0000X	Family Nurse Practitioner	95034313	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528618121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN DAVID GAGER NP

Provider Business Mailing Address
First Line	:	1432 CREEK SPRINGS DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-0993
Country	:	US
Telephone Number	:	214-385-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E ELDORADO PKWY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5999
Country	:	US
Telephone Number	:	972-987-0458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	07/17/2025

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Directions to “ ETHAN DAVID GAGER NP” Practice Location

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