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General NPI Number Information
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NPI Number | 1346600210
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Entity Type | Organization
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Legal Business Name | GBC MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 237 SOUTH GUN BARREL LANE
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City | GUN BARREL CITY
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State | TX
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Zip | 75156
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Country | US
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Telephone | 903-887-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 237 SOUTH GUN BARREL LANE
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City | GUN BARREL CITY
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State | TX
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Zip | 75156
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Country | US
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Telephone | 903-887-8884
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MARY MOODY
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Credential | FNP-BC, APRN
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Telephone | 214-908-9463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP126911
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License Number State | TX
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