MEDICARE: GALVEZ DOCTORS CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	09539R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073569117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALVEZ DOCTORS CLINIC, INC

Provider Business Mailing Address
First Line	:	1407 PIETY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6035
Country	:	US
Telephone Number	:	504-940-0820
Fax Number	:	504-466-6209

Provider Business Practice Location Address
First Line	:	1407 PIETY ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6035
Country	:	US
Telephone Number	:	504-940-0820
Fax Number	:	504-466-6209

Authorized Official
Title or Position	:	CEO ADMINISTRATOR
Name	:	THERESA PETERS FISHER
Credential	:
Telephone Number	:	504-940-0820

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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