MEDICARE: GARY M SACKRISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K1648	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407831357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY M SACKRISON M.D.

Provider Business Mailing Address
First Line	:	2821 E. PRESIDENT GEORGE BUSH FREEWAY
Second Line	:	SUITE 404
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4266
Country	:	US
Telephone Number	:	214-576-2227
Fax Number	:	214-576-2229

Provider Business Practice Location Address
First Line	:	2821 E PRESIDENT GEORGE BUSH FREEWAY
Second Line	:	SUITE 404
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4266
Country	:	US
Telephone Number	:	214-576-2227
Fax Number	:	214-576-2229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	06/16/2015

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