Provider Demographics
NPI:1356598338
Name:LUIS GASTON PRIETO, M.D., P.A.
Entity type:Organization
Organization Name:LUIS GASTON PRIETO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-227-0195
Mailing Address - Street 1:730 N MAIN AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-227-0195
Mailing Address - Fax:210-227-0196
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-227-0195
Practice Address - Fax:210-227-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z420Medicare PIN
F97484Medicare UPIN