Healthcare Provider Details

I. General information

NPI: 1487667184
Provider Name (Legal Business Name): MENNEN T GALLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S FRY RD STE 102
KATY TX
77450
US

IV. Provider business mailing address

777 S FRY RD STE 102
KATY TX
77450
US

V. Phone/Fax

Practice location:
  • Phone: 281-646-1114
  • Fax: 281-646-1138
Mailing address:
  • Phone: 281-646-1114
  • Fax: 281-646-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberK5105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: