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General NPI Number Information
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NPI Number | 1346554656
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Entity Type | Organization
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Legal Business Name | RGV RADIOLOGY, PLLC
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 5501 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-9152
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Country | US
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Telephone | 956-661-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 INTERNATIONAL PLZ SUITE 240
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City | FORT WORTH
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State | TX
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Zip | 76109-4820
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Country | US
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Telephone | 817-570-7300
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Fax | 817-570-7062
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY PALLARES
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Credential | MD
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Telephone | 956-661-7558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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