Provider Demographics
NPI:1528257383
Name:ERWIN, GARY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDWARD
Last Name:ERWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 FM 1960 RD W STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4405
Mailing Address - Country:US
Mailing Address - Phone:281-587-2316
Mailing Address - Fax:
Practice Address - Street 1:5206 FM 1960 RD W STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4405
Practice Address - Country:US
Practice Address - Phone:281-587-2316
Practice Address - Fax:281-587-2615
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7024207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032318001Medicaid
TX00BP96Medicare PIN
TX032318001Medicaid