MEDICARE: MAX GERALD GAROUTTE M.D.

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	H9639	TX
2	207RC0000X	Cardiovascular Disease Physician	H9639	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0955862	OTHER	TX	CLIA
2	752646025	OTHER		TAX ID
3	3063865	OTHER		CIGNA
4	83Z820	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235135344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX GERALD GAROUTTE M.D.

Provider Business Mailing Address
First Line	:	1003 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-654-6000
Fax Number	:	210-654-6014

Provider Business Practice Location Address
First Line	:	1003 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-654-6000
Fax Number	:	210-654-6014

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/24/2011

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