MEDICARE: GARY L GILCREASE MD, PA

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	K9069	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
2	K9069	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1568654887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY L GILCREASE MD, PA

Provider Business Mailing Address
First Line	:	135 BUNTON CREEK RD STE 102
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-5701
Country	:	US
Telephone Number	:	512-268-2091
Fax Number	:	512-268-2190

Provider Business Practice Location Address
First Line	:	135 BUNTON CREEK RD STE 102
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-5701
Country	:	US
Telephone Number	:	512-268-2091
Fax Number	:	512-268-2190

Authorized Official
Title or Position	:	MD, PRESIDENT, OWNER
Name	:	DR. GARY L GILCREASE
Credential	:	MD, PA
Telephone Number	:	512-268-2091

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	02/23/2022

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