Basic Information
| Provider Information | |||||||||
| NPI: | 1750322954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERWIN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2965 PHYLLIS LN | ||||||||
| Address2: | |||||||||
| City: | FARMERS BRANCH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752346424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722436255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 N MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750612220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725798485 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L5323 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | L5323 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | L5323 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 158266001 | 05 | TX | MEDICAID |