Individual
GAUTAM BASKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 E MARSHALL AVE STE 5001, LONGVIEW, TX 75601-5524
(903) 315-4551
(903) 315-3415
Mailing address
705 E MARSHALL AVE STE 5001, LONGVIEW, TX 75601-5524
(903) 315-4551
(903) 315-3415
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
2011014212
MO
207RP1001X
Pulmonary Disease Physician
Primary
Q0003
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335691703
—
TX
01
—
P02599916
MCRR
TX
Enumeration date
06/05/2008
Last updated
06/17/2024
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