Healthcare Provider Details

I. General information

NPI: 1235330416
Provider Name (Legal Business Name): WALTER A. DEL GALLO, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FLOURNOY RD
ALICE TX
78332-4085
US

IV. Provider business mailing address

14317 NORTHWEST BLVD SUITE A
CORPUS CHRISTI TX
78410-5536
US

V. Phone/Fax

Practice location:
  • Phone: 361-664-0562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberK0710
License Number StateTX

VIII. Authorized Official

Name: DR. WALTER A DEL GALLO
Title or Position: OWNER
Credential:
Phone: 361-241-0324