Healthcare Provider Details

I. General information

NPI: 1780746644
Provider Name (Legal Business Name): WALTER A DELGALLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14317 NW BLVD SUITE A
CORPUS CHRISTI TX
78410
US

IV. Provider business mailing address

14317 NW BLVD SUITE A
CORPUS CHRISTI TX
78410
US

V. Phone/Fax

Practice location:
  • Phone: 361-241-0324
  • Fax: 361-387-4153
Mailing address:
  • Phone: 361-241-0324
  • Fax: 361-387-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberK0710
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: