Healthcare Provider Details

I. General information

NPI: 1518987163
Provider Name (Legal Business Name): JOHN WHITHURST GALLASPY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 410
ALEXANDRIA LA
71301
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-2400
  • Fax: 318-442-2427
Mailing address:
  • Phone: 903-614-5372
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number108939
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD018939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: