Provider Demographics
NPI:1255534863
Name:GAVINO, ALDE CARLO (MD)
Entity type:Individual
Prefix:DR
First Name:ALDE CARLO
Middle Name:
Last Name:GAVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALDE CARLO
Other - Middle Name:PATDU
Other - Last Name:GAVINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9073 W HWY 29, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:737-377-3143
Mailing Address - Fax:737-200-8237
Practice Address - Street 1:9073 W STATE HIGHWAY 29 STE 108
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2396
Practice Address - Country:US
Practice Address - Phone:737-377-3143
Practice Address - Fax:737-200-8237
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8917207N00000X, 207ZP0102X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP20036791OtherINSTITUTIONAL PERMIT
TX341151YKZCMedicare PIN
TXTXB162750Medicare PIN
TXTXB162750Medicare PIN
TX305479304Medicaid