Healthcare Provider Details

I. General information

NPI: 1316306665
Provider Name (Legal Business Name): MAX GILOT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 PARADISE ST
VERNON TX
76384-5226
US

IV. Provider business mailing address

2629 PARADISE ST
VERNON TX
76384-5226
US

V. Phone/Fax

Practice location:
  • Phone: 940-782-2219
  • Fax:
Mailing address:
  • Phone: 940-782-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1238873
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: