Individual
MAX GERALD GAROUTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1003 NE LOOP 410, SAN ANTONIO, TX 78209-1205
(210) 654-6000
(210) 654-6014
Mailing address
1003 NE LOOP 410, SAN ANTONIO, TX 78209-1205
(210) 654-6000
(210) 654-6014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
H9639
TX
207RC0000X
Cardiovascular Disease Physician
Primary
H9639
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085790601
—
TX
01
—
3063865
CIGNA
—
01
—
45D0955862
CLIA
TX
01
—
752646025
TAX ID
—
01
—
83Z820
BCBS
TX
Enumeration date
06/23/2005
Last updated
03/24/2011
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