Provider Demographics
NPI:1275605974
Name:GAITAN, LUIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
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:PO BOX 676786
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6786
Mailing Address - Country:US
Mailing Address - Phone:956-548-1139
Mailing Address - Fax:956-550-9050
Practice Address - Street 1:4770 N EXPRESSWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4120
Practice Address - Country:US
Practice Address - Phone:956-550-9020
Practice Address - Fax:956-550-9050
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK14422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118823704Medicaid
TX200076095OtherEMPLOYER IDENTIFICATION N
TX0043KHOtherBCBS NUMBER
TXP00039432OtherPIN MEDICARE RAILROAD
TX8A8983Medicare ID - Type UnspecifiedINDIVIDUAL
TXP00039432OtherPIN MEDICARE RAILROAD