Healthcare Provider Details

I. General information

NPI: 1710200506
Provider Name (Legal Business Name): W.GORDY DAY,M.D.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S JACKSON ST
SAN ANGELO TX
76904-5129
US

IV. Provider business mailing address

3001 S JACKSON ST
SAN ANGELO TX
76904-5129
US

V. Phone/Fax

Practice location:
  • Phone: 325-223-6347
  • Fax: 325-223-6377
Mailing address:
  • Phone: 325-223-6347
  • Fax: 325-223-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG3277
License Number StateTX

VIII. Authorized Official

Name: WALTER GORDY DAY
Title or Position: M.D.
Credential:
Phone: 325-223-6347