Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0103301287 | VA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 3093 | TX |
NPI | 1346773066 |
---|---|
Provider Name | Gary Driver |
First Address | Fort Worth, TX 76132-3936 |
Second Address | Fort Worth, TX 76132-3936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 20/07/2021 |