=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316331317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR GARRY GUCE AND ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2015
-----------------------------------------------------
Last Update Date | 03/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 874 ED HALL DR STE 106
-----------------------------------------------------
City | KAUFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75142-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-932-5270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 CLUBVIEW DR
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087-3185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-512-1367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT BILLING ASSISTANT
-----------------------------------------------------
Name | DONNA BIVEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-215-3325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | N7094
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------