Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 184517-1205 | UT |
NPI | 1083765226 |
---|---|
Provider Name | Gary Andrew Dildy III |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003671100 | (05) | ID |
184517-8905 | MEDICAL LICENSE (01) | UT |
F00528 | (02) |