Provider Demographics
NPI:1093886293
Name:GAITAN, JAIME L (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:GAITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1746
Mailing Address - Country:US
Mailing Address - Phone:305-227-6008
Mailing Address - Fax:305-227-1062
Practice Address - Street 1:10326 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1746
Practice Address - Country:US
Practice Address - Phone:305-227-6008
Practice Address - Fax:305-227-1062
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0044889208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069559900Medicaid
FLD63905Medicare UPIN
FL96575Medicare ID - Type Unspecified