Healthcare Provider Details

I. General information

NPI: 1346554656
Provider Name (Legal Business Name): RGV RADIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S MCCOLL RD
EDINBURG TX
78539-9152
US

IV. Provider business mailing address

4100 INTERNATIONAL PLZ SUITE 240
FORT WORTH TX
76109-4820
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-7100
  • Fax:
Mailing address:
  • Phone: 817-570-7300
  • Fax: 817-570-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY PALLARES
Title or Position: PRESIDENT
Credential: MD
Phone: 956-661-7558