Healthcare Provider Details

I. General information

NPI: 1134155005
Provider Name (Legal Business Name): MIN GAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 PINE ST SUITE 200
ABILENE TX
79601-2449
US

IV. Provider business mailing address

PO BOX 1198
ABILENE TX
79604-1198
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-5570
  • Fax: 325-670-4773
Mailing address:
  • Phone: 325-670-4220
  • Fax: 325-670-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN2518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: