MEDICARE: DR. GERARDO DAVID CAMORIANO NOLASCO 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	207W00000X	Ophthalmology Physician	BP10029074	TX

General Provider Information

NPI Number	:	1265620256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO DAVID CAMORIANO NOLASCO MD

Provider Business Mailing Address
First Line	:	UNIVERSITY OF TEXAS MEDICAL BRANCH-OPHTHALMOLOGY
Second Line	:	301 UNIVERSITY BLVD
City	:	GALVESTON
State	:	TX
Zip	:	77555-1106
Country	:	US
Telephone Number	:	409-747-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF TEXAS MEDICAL BRANCH-OPHTHALMOLOGY
Second Line	:	301 UNIVERSITY BLVD
City	:	GALVESTON
State	:	TX
Zip	:	77555-1106
Country	:	US
Telephone Number	:	409-747-5801
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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