Provider Demographics
NPI:1679713960
Name:GAHAN, JEFFREY CHAD (JEFFREY GAHAN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHAD
Last Name:GAHAN
Suffix:
Gender:M
Credentials:JEFFREY GAHAN
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:GAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JEFFREY GAHAN
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:305-397-7025
Mailing Address - Fax:
Practice Address - Street 1:600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:305-397-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11744390200000X
TXP3325208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program