Provider Demographics
NPI:1972744365
Name:GABINO-MIRANDA, GUSTAVO ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ANDRES
Last Name:GABINO-MIRANDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4458 MEDICAL DR
Mailing Address - Street 2:STE 505
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3748
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:210-690-7405
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:STE 230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP8903207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339466001Medicaid
TX369128YM6WMedicare PIN