MEDICARE: AVA WILLIAMSON GALLAGHER MD

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	208000000X	Pediatrics Physician	42763	TX

General Provider Information

NPI Number	:	1396975397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA WILLIAMSON GALLAGHER MD

Provider Business Mailing Address
First Line	:	925 WESTBANK DR STE 100
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6648
Country	:	US
Telephone Number	:	512-327-0411
Fax Number	:	512-327-5437

Provider Business Practice Location Address
First Line	:	925 WESTBANK DR STE 100
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6648
Country	:	US
Telephone Number	:	512-327-0411
Fax Number	:	512-327-5437

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	11/09/2016

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