Healthcare Provider Details

I. General information

NPI: 1699762781
Provider Name (Legal Business Name): DEBORAH LOUISE GANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BROADWAY ST
PEARLAND TX
77581-5501
US

IV. Provider business mailing address

2017 BROADWAY ST
PEARLAND TX
77581-5501
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-9990
  • Fax: 281-485-9469
Mailing address:
  • Phone: 281-485-9990
  • Fax: 281-485-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH7609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: