Provider Demographics
NPI:1073792826
Name:AJAY GAALLA, P A
Entity Type:Organization
Organization Name:AJAY GAALLA, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-580-2200
Mailing Address - Street 1:2104 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5639
Mailing Address - Country:US
Mailing Address - Phone:361-580-2200
Mailing Address - Fax:361-580-2201
Practice Address - Street 1:2104 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5639
Practice Address - Country:US
Practice Address - Phone:361-580-2200
Practice Address - Fax:361-580-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4134207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113733304Medicaid
TX8BF139OtherBCBS
TX8BF139OtherBCBS
TXG69816Medicare UPIN