Provider Demographics
NPI:1922044510
Name:GAITZ, .JEFFREY PRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:.JEFFREY
Middle Name:PRESTON
Last Name:GAITZ
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 1:1740 W 27TH ST
Mailing Address - Street 2:#206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-861-6555
Mailing Address - Fax:713-861-4589
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:#206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-861-6555
Practice Address - Fax:713-861-4589
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE90702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113975001Medicaid
TX00AD21Medicare ID - Type Unspecified
TX113975001Medicaid