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General NPI Number Information
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NPI Number | 1295013233
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Entity Type | Organization
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Legal Business Name | DAYAKER R. GAGADAM M.D.PA
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 11803 SOUTH FWY SUITE 208
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City | BURLESON
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State | TX
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Zip | 76028-7012
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Country | US
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Telephone | 817-293-3000
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Fax | 817-293-3291
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Provider Business Mailing Address
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Address Line | 11803 SOUTH FWY SUITE 208
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City | BURLESON
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State | TX
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Zip | 76028-7012
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Country | US
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Telephone | 817-293-3000
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Fax | 817-293-3291
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAYAKER RAO GAGADAM
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Credential | M.D.,
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Telephone | 817-293-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | K3195
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License Number State | TX
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