Provider Demographics
NPI:1609959030
Name:GAITONDE, GAJANAN VISHWANATH (MD)
Entity Type:Individual
Prefix:DR
First Name:GAJANAN
Middle Name:VISHWANATH
Last Name:GAITONDE
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 1:101 JOLLEY ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4815
Mailing Address - Country:US
Mailing Address - Phone:830-278-4568
Mailing Address - Fax:830-278-4569
Practice Address - Street 1:101 JOLLEY ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4815
Practice Address - Country:US
Practice Address - Phone:830-278-4568
Practice Address - Fax:830-278-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1011208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099989903Medicaid
TX099989903Medicaid
TX8D1022Medicare ID - Type Unspecified