Healthcare Provider Details

I. General information

NPI: 1669449104
Provider Name (Legal Business Name): PAUL G GAITAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N. TATUM BLVD BLDG F, SUITE 101
PHOENIX AZ
85028
US

IV. Provider business mailing address

11030 N. TATUM BLVD BLDG F, SUITE 101
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9880
  • Fax: 480-393-7444
Mailing address:
  • Phone: 602-889-9880
  • Fax: 408-393-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32717
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: