Provider Demographics
NPI:1801906656
Name:GAGE, JAMES TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TERRY
Last Name:GAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:GAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4102 24TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1804
Mailing Address - Country:US
Mailing Address - Phone:806-793-5683
Mailing Address - Fax:806-793-3821
Practice Address - Street 1:4102 24TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1804
Practice Address - Country:US
Practice Address - Phone:806-793-5683
Practice Address - Fax:806-793-3821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111493606Medicaid
TX00K77MOtherBLUECROSS BLUESHIELD
C15837Medicare UPIN
TX111493606Medicaid