Basic Information
| Provider Information | |||||||||
| NPI: | 1831148170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GMITTER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | CHRIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 W 34TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | J8552 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 139293819 | 05 | TX | MEDICAID | 84722Y | 01 | TX | BCBS | OTHER | 139293811 | 05 | TX | MEDICAID | 139293816 | 01 | TX | CIDC | OTHER | 8K9557 | 01 | TX | BCBS | OTHER | 139293803 | 05 | TX | MEDICAID | 139293816 | 01 | TX | CSHCN | OTHER | 83042F | 01 | TX | BCBS OF TX | OTHER | 139293809 | 01 | TX | CSHCN | OTHER | 139293810 | 05 | TX | MEDICAID |