Individual
RAFAEL J GAYTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MERCY WAY, SUITE 320-330, JOPLIN, MO 64804-4524
(417) 781-5387
(417) 781-7174
Mailing address
100 MERCY WAY, SUITE 320-330, JOPLIN, MO 64804-4524
(417) 781-5387
(417) 781-7174
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
2006038051
MO
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
2006038051
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200101900A
—
OK
05
—
200418840C
—
KS
05
—
206295701
—
MO
01
—
P00800214
RAIL ROAD MEDICARE
MO
Enumeration date
12/06/2006
Last updated
03/17/2016
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