Provider Demographics
NPI:1447296975
Name:AKPASSA, GERALD J (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:AKPASSA
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 1:409 COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-1466
Mailing Address - Country:US
Mailing Address - Phone:903-693-3841
Mailing Address - Fax:
Practice Address - Street 1:1029 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6228
Practice Address - Country:US
Practice Address - Phone:903-239-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1419207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177597501Medicaid
TX177597503Medicaid
TX177597503Medicaid
TX177597501Medicaid
TXI41182Medicare UPIN