Healthcare Provider Details

I. General information

NPI: 1295013233
Provider Name (Legal Business Name): DAYAKER R. GAGADAM M.D.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 SOUTH FWY SUITE 208
BURLESON TX
76028-7012
US

IV. Provider business mailing address

11803 SOUTH FWY SUITE 208
BURLESON TX
76028-7012
US

V. Phone/Fax

Practice location:
  • Phone: 817-293-3000
  • Fax: 817-293-3291
Mailing address:
  • Phone: 817-293-3000
  • Fax: 817-293-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberK3195
License Number StateTX

VIII. Authorized Official

Name: DR. DAYAKER RAO GAGADAM
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 817-293-3000