Provider Demographics
NPI:1891757761
Name:GARCIAGAYOSO, AILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:
Last Name:GARCIAGAYOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:GAYOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-569-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15680207R00000X
TN35751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSG70774Medicare UPIN
MS512G700249Medicare PIN
TN3870443Medicare ID - Type Unspecified
MS110001590Medicare ID - Type Unspecified