Provider Demographics
NPI:1083053458
Name:GAJAN, JOSEPH ULYSSES IV (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ULYSSES
Last Name:GAJAN
Suffix:IV
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF TEXAS MEDICAL BR
Mailing Address - Street 2:301 UNIVERSITY BLVD.
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0523
Mailing Address - Country:US
Mailing Address - Phone:409-772-2711
Mailing Address - Fax:409-747-2185
Practice Address - Street 1:UNIVERSITY OF TEXAS MEDICAL BR
Practice Address - Street 2:301 UNIVERSITY BLVD.
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0523
Practice Address - Country:US
Practice Address - Phone:409-772-2711
Practice Address - Fax:409-747-2185
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80601231H00000X, 231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80601OtherLICENSURE