MEDICARE: DR. ARIANNE MARIA GALLATY M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	S5620	TX
3	207R00000X	Internal Medicine Physician	S5620	TX

General Provider Information

NPI Number	:	1285053140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARIANNE MARIA GALLATY M.D.

Provider Business Mailing Address
First Line	:	800 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4611
Country	:	US
Telephone Number	:	817-759-7000
Fax Number	:	817-759-7027

Provider Business Practice Location Address
First Line	:	3025 N TARRANT PKWY STE 240
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8626
Country	:	US
Telephone Number	:	817-759-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	02/20/2025

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