Provider Demographics
NPI:1073569117
Name:GALVEZ DOCTORS CLINIC, INC
Entity Type:Organization
Organization Name:GALVEZ DOCTORS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:PETERS
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-940-0820
Mailing Address - Street 1:1407 PIETY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-6035
Mailing Address - Country:US
Mailing Address - Phone:504-940-0820
Mailing Address - Fax:504-466-6209
Practice Address - Street 1:1407 PIETY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-6035
Practice Address - Country:US
Practice Address - Phone:504-940-0820
Practice Address - Fax:504-466-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09539R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445258Medicaid
LA1445258Medicaid