MEDICARE: DR. LUIS E GAITAN 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	2084N0400X	Neurology Physician	K1442	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00039432	OTHER	TX	PIN MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	200076095	OTHER	TX	EMPLOYER IDENTIFICATION N
3	0043KH	OTHER	TX	BCBS NUMBER

General Provider Information

NPI Number	:	1275605974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS E GAITAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 676786
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-6786
Country	:	US
Telephone Number	:	956-548-1139
Fax Number	:	956-550-9050

Provider Business Practice Location Address
First Line	:	4770 N EXPRESSWAY
Second Line	:	SUITE 100
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-550-9020
Fax Number	:	956-550-9050

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	05/12/2022

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Directions to “ DR. LUIS E GAITAN M.D.” Practice Location

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