Provider Demographics
NPI:1790049732
Name:OLGIN, GAUDENCIO (MD)
Entity Type:Individual
Prefix:
First Name:GAUDENCIO
Middle Name:
Last Name:OLGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3989
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3989
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-362-2548
Practice Address - Street 1:2603 MICHAEL ANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-362-8767
Practice Address - Fax:956-362-2548
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP9675208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337964601Medicaid
TX363649YNMFMedicare PIN