Healthcare Provider Details

I. General information

NPI: 1629333786
Provider Name (Legal Business Name): HERVEY GALVAN MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W.EDINBURG HWY 107
ELSA TX
78543-0000
US

IV. Provider business mailing address

200 W EDINBURG HWY 107
ELSA TX
78543
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-9804
  • Fax: 956-262-9233
Mailing address:
  • Phone: 956-262-9804
  • Fax: 956-262-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA04302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: