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NPI Code Detail

MEDICARE: MAURICE R GAGNON MD

MEDICARE: MAURICE R GAGNON MD
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
1207V00000XObstetrics & Gynecology PhysicianF3464TX

Other Identifiers

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

General Provider Information

NPI Number : 1720015688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURICE R GAGNON MD
Provider Business Mailing Address
First Line : P.O. BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-745-2601
Provider Business Practice Location Address
First Line : 1141 KELLER PARKWAY
Second Line : STE A
City : KELLER
State : TX
Zip : 76248-1628
Country : US
Telephone Number : 817-741-2601
Fax Number : 817-745-2601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 04/03/2013

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