Provider Demographics
NPI:1386087583
Name:GAITAN, SERGIO REYNALDO (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:REYNALDO
Last Name:GAITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2879
Mailing Address - Country:US
Mailing Address - Phone:786-564-6612
Mailing Address - Fax:
Practice Address - Street 1:9060 SW 73RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2961
Practice Address - Country:US
Practice Address - Phone:305-670-1111
Practice Address - Fax:305-670-1110
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130475207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology