Provider Demographics
NPI:1801303979
Name:GULF COAST NEONATOLOGY, PLLC
Entity type:Organization
Organization Name:GULF COAST NEONATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-692-8550
Mailing Address - Street 1:5920 SARATOGA BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4124
Mailing Address - Country:US
Mailing Address - Phone:361-692-8550
Mailing Address - Fax:361-356-6681
Practice Address - Street 1:5920 SARATOGA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4124
Practice Address - Country:US
Practice Address - Phone:361-463-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM75642080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1255370573Medicaid
TX1700085123Medicaid