MEDICARE: GALO A RODARTE MD PA

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1629273305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALO A RODARTE MD PA

Provider Business Mailing Address
First Line	:	400 EAST ROBINSON # A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2619
Country	:	US
Telephone Number	:	915-532-9220
Fax Number	:	915-532-9230

Provider Business Practice Location Address
First Line	:	400 E ROBINSON AVE
Second Line	:	STE A
City	:	EL PASO
State	:	TX
Zip	:	79902-2619
Country	:	US
Telephone Number	:	915-532-9220
Fax Number	:	915-532-9230

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARIA E ENRIQUEZ
Credential	:
Telephone Number	:	915-532-9220

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	11/07/2007

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