Provider Demographics
NPI:1841188364
Name:SPINE AND REGENERATIVE MEDICINE PLLC
Entity type:Organization
Organization Name:SPINE AND REGENERATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-889-9880
Mailing Address - Street 1:11030 N TATUM BLVD
Mailing Address - Street 2:BLDG F, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-889-9880
Mailing Address - Fax:480-393-7444
Practice Address - Street 1:11030 N TATUM BLVD
Practice Address - Street 2:BLDG F, SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-889-9880
Practice Address - Fax:480-393-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty