Healthcare Provider Details

I. General information

NPI: 1700886470
Provider Name (Legal Business Name): GERARDO JOSE PINEIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MALLARD LN
TAYLOR TX
76574-1208
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-7611
  • Fax: 512-352-4734
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM9764
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: