Healthcare Provider Details

I. General information

NPI: 1275641367
Provider Name (Legal Business Name): JOHN THOMAS GALDAMEZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E DOWNING ST TAHLEQUAH CITY HOSPITAL
TAHLEQUAH OK
74464-3324
US

IV. Provider business mailing address

CHEROKEE ELDER CARE 1387 W 4TH ST
TAHLEQUAH OK
74464
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-0641
  • Fax: 918-453-2359
Mailing address:
  • Phone: 918-453-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2918
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100006330A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: