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General NPI Number Information
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NPI Number | 1144425612
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Entity Type | Individual
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Provider Name | GABRIEL RAYMOND NANAGAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 3211 PRESTON RD STE 5
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City | FRISCO
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State | TX
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Zip | 75034-9020
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Country | US
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Telephone | 469-213-7996
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Fax |
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Provider Business Mailing Address
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Address Line | 2329 TAMARISK LN
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City | PLANO
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State | TX
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Zip | 75023-6422
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Country | US
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Telephone | 972-596-9293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01958
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License Number State | TX
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