Individual
DR. MYSTAN ASHLEY GURKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
604 HIGHWAY 290 W, BRENHAM, TX 77833-5432
(979) 421-2000
(979) 421-9678
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
K7163
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159869001
—
TX
05
—
159869004
—
TX
01
—
8DE529
BC/BS #
TX
01
—
8J1711
BC/BX TX#
TX
01
—
MDK7163TX
WORKERS COMPENSATION
TX
01
—
P0062953
RAILROAD GBA - RAILROAD MEDICARE
TX
01
—
P01090493
RAILROAD MEDICARE PTAN
TX
Enumeration date
04/11/2006
Last updated
12/09/2021
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