Provider Demographics
NPI:1952334963
Name:GWOSDZ-GILMAN, ELAINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MARIE
Last Name:GWOSDZ-GILMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MAIN PLZ STE 365
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5136
Mailing Address - Country:US
Mailing Address - Phone:210-710-4265
Mailing Address - Fax:830-620-5405
Practice Address - Street 1:301 MAIN PLZ STE 365
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5136
Practice Address - Country:US
Practice Address - Phone:210-710-4265
Practice Address - Fax:830-620-5405
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84790KOtherBLUE CROSS BLUE SHIELD
TXG77885Medicare UPIN
TX84790KMedicare ID - Type UnspecifiedMEDICARE ISSUED