Provider Demographics
NPI:1538370804
Name:GAITOUR, EMIL (MD)
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:GAITOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMIL
Other - Middle Name:
Other - Last Name:GAYTUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6311 COLONIAL GRAND DR
Mailing Address - Street 2:206
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3696
Mailing Address - Country:US
Mailing Address - Phone:917-597-3644
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:127
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2602852084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50977Medicaid