Provider Demographics
NPI:1902072457
Name:GARY M PARKHURST, M.D., PA
Entity Type:Organization
Organization Name:GARY M PARKHURST, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-0007
Mailing Address - Street 1:404 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2852
Mailing Address - Country:US
Mailing Address - Phone:903-723-0007
Mailing Address - Fax:903-729-1069
Practice Address - Street 1:404 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2852
Practice Address - Country:US
Practice Address - Phone:903-723-0007
Practice Address - Fax:903-729-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00911WMedicare PIN