Provider Demographics
NPI:1205885837
Name:LUIS GAITAN, MD., PA.
Entity type:Organization
Organization Name:LUIS GAITAN, MD., PA.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-550-9020
Mailing Address - Street 1:PO BOX 676786
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6786
Mailing Address - Country:US
Mailing Address - Phone:956-550-9020
Mailing Address - Fax:956-550-9050
Practice Address - Street 1:4770 N EXPRESSWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4120
Practice Address - Country:US
Practice Address - Phone:956-550-9020
Practice Address - Fax:956-550-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK14422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDA4272OtherGROUP # MEDICARE RAILROAD
TX0043KHOtherBCBS NUMBER
TX139289100OtherVALLEY BAPTIST HEALTH PLA
TX159853401Medicaid
TX139289100OtherVALLEY BAPTIST HEALTH PLA
TX00478VMedicare ID - Type UnspecifiedGROUP
G51155Medicare UPIN