Provider Demographics
NPI:1043211816
Name:GATMAITAN, BIENVENIDO GATMAITAN
Entity Type:Individual
Prefix:DR
First Name:BIENVENIDO
Middle Name:GATMAITAN
Last Name:GATMAITAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MATLOCK CENTRE CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2535
Mailing Address - Country:US
Mailing Address - Phone:817-860-6062
Mailing Address - Fax:817-795-6652
Practice Address - Street 1:621 MATLOCK CENTRE CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2535
Practice Address - Country:US
Practice Address - Phone:817-860-6062
Practice Address - Fax:817-795-6652
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9652207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16026Medicare UPIN
TXME0077Medicare ID - Type Unspecified