Provider Demographics
NPI:1407969140
Name:EGELSEE, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:EGELSEE
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 1:651 N US HWY 183
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-528-0432
Mailing Address - Fax:512-528-0452
Practice Address - Street 1:651 N HIGHWAY 183 STE 110
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7002
Practice Address - Country:US
Practice Address - Phone:512-528-0432
Practice Address - Fax:512-528-0452
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65256207Q00000X
TXN5030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A652560Medicaid
TXPENDINGMedicaid
CACG850ZMedicare PIN
TXTXB107418Medicare PIN
CA00A652560Medicaid