Provider Demographics
NPI:1770681058
Name:MAISLOS, GABRIEL ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALEXANDER
Last Name:MAISLOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESLAYAN ST STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5132
Mailing Address - Country:US
Mailing Address - Phone:713-541-3199
Mailing Address - Fax:713-541-5809
Practice Address - Street 1:2900 WESLAYAN ST STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5132
Practice Address - Country:US
Practice Address - Phone:713-541-3199
Practice Address - Fax:713-541-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1576P213ES0103X
332B00000X
TX1576213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147117902Medicaid
TX51KMOtherBLUE CROSS BLUE SHIELD
TX10012478OtherAMERIGROUP
4949190001Medicare NSC
TX10012478OtherAMERIGROUP
TX51KMOtherBLUE CROSS BLUE SHIELD