Healthcare Provider Details

I. General information

NPI: 1154697282
Provider Name (Legal Business Name): DENNIS GEORGE GUMBRECHT II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FERRIS AVE
WAXAHACHIE TX
75165-3030
US

IV. Provider business mailing address

5520 LBJ FWY STE 200
DALLAS TX
75240-6381
US

V. Phone/Fax

Practice location:
  • Phone: 972-497-2655
  • Fax: 214-594-9425
Mailing address:
  • Phone:
  • Fax: 972-408-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036.136.165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: