Provider Demographics
NPI:1003857897
Name:GALEANO, JOSE W (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:W
Last Name:GALEANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:W
Other - Last Name:GALEANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:405 LONDONDERRY DR
Mailing Address - Street 2:STE 204
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7924
Mailing Address - Country:US
Mailing Address - Phone:254-756-7474
Mailing Address - Fax:254-741-6906
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:STE 204
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-756-7474
Practice Address - Fax:254-741-6906
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110239401Medicaid
TX110239401Medicaid