Healthcare Provider Details

I. General information

NPI: 1184835019
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: 05/24/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 GENERAL CAVAZOS BLVD #204
KINGSVILLE TX
78363-7129
US

IV. Provider business mailing address

14317 NW BLVD STE A
CRP CHRISTI TX
78410-5536
US

V. Phone/Fax

Practice location:
  • Phone: 361-595-5086
  • 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: M.D.
Phone: 361-241-0324