Healthcare Provider Details

I. General information

NPI: 1326018797
Provider Name (Legal Business Name): GARY BABBITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/20/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FM 2137 N
BULLARD TX
75757-7331
US

IV. Provider business mailing address

PO BOX 5500
TYLER TX
75712-5500
US

V. Phone/Fax

Practice location:
  • Phone: 903-714-1704
  • Fax:
Mailing address:
  • Phone: 903-324-6450
  • Fax: 903-593-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG9321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: