Provider Demographics
NPI:1871631275
Name:AILEEN GAYOSO, MD, PLLC
Entity Type:Organization
Organization Name:AILEEN GAYOSO, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-569-0519
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 311
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-569-0519
Mailing Address - Fax:
Practice Address - Street 1:8756 GUMLEAF CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7358
Practice Address - Country:US
Practice Address - Phone:901-569-0519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15680207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS110001590Medicaid
MSG70774Medicare UPIN