MEDICARE: VIVIAN IRIZARRY GATELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125066363	IL
2	207RH0003X	Hematology & Oncology Physician	U5129	TX
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RX0202X	Medical Oncology Physician	U5129	TX

General Provider Information

NPI Number	:	1013302645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN IRIZARRY GATELL MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 INWOOD RD 2ND FL STE 130
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7320
Country	:	US
Telephone Number	:	214-645-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	12/12/2023

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