Provider Demographics
NPI:1376686840
Name:BRITZ, GAVIN W (MD)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:W
Last Name:BRITZ
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 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-3800
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037874207T00000X
NC2007-01099207T00000X, 2085R0202X
TXP5938207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GD815OtherBCBS
NC5907075Medicaid
2846OtherINTERNAL ID-MOTOR VEHICLE ID
TX323192002Medicaid
TXP01331461OtherRR MEDICARE
WA8247652Medicaid
H02079Medicare UPIN
TX286229ZSWDMedicare PIN
NC5907075Medicaid
2846OtherINTERNAL ID-MOTOR VEHICLE ID
TX286229YMVQMedicare PIN