Provider Demographics
NPI:1598865636
Name:GAITAN, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:425 N NEW BALLAS RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6845
Mailing Address - Country:US
Mailing Address - Phone:314-432-2592
Mailing Address - Fax:
Practice Address - Street 1:425 N NEW BALLAS RD STE 107
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6845
Practice Address - Country:US
Practice Address - Phone:314-432-2592
Practice Address - Fax:314-432-2595
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103118207RE0101X, 207R00000X
MOMD103118207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO003013412Medicare ID - Type Unspecified
F54225Medicare UPIN