Provider Demographics
NPI:1154331007
Name:PRIETO, LUIS GASTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GASTON
Last Name:PRIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GASTON
Other - Middle Name:
Other - Last Name:PRIETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:730 N MAIN AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-227-0195
Mailing Address - Fax:210-227-0196
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-227-0195
Practice Address - Fax:210-227-0196
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0848285Medicaid
TX8F8508Medicare PIN
TX0848285Medicaid