Provider Demographics
NPI:1235135344
Name:GAROUTTE, MAX GERALD (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:GERALD
Last Name:GAROUTTE
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 1:1003 NE LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1205
Mailing Address - Country:US
Mailing Address - Phone:210-654-6000
Mailing Address - Fax:210-654-6014
Practice Address - Street 1:1003 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1205
Practice Address - Country:US
Practice Address - Phone:210-654-6000
Practice Address - Fax:210-654-6014
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9639207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0955862OtherCLIA
752646025OtherTAX ID
3063865OtherCIGNA
TX83Z820OtherBCBS
TX085790601Medicaid
TX085790601Medicaid
3063865OtherCIGNA
TX83Z820Medicare ID - Type UnspecifiedPROVIDER NUMBER