Provider Demographics
NPI:1205958212
Name:GAYTAN, EDELMIRO (LMT)
Entity type:Individual
Prefix:MR
First Name:EDELMIRO
Middle Name:
Last Name:GAYTAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E PRICE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2235
Mailing Address - Country:US
Mailing Address - Phone:956-504-9131
Mailing Address - Fax:956-504-9654
Practice Address - Street 1:2701 E PRICE RD
Practice Address - Street 2:SUITE I
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2235
Practice Address - Country:US
Practice Address - Phone:956-504-9131
Practice Address - Fax:956-504-9654
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX044155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist