Provider Demographics
NPI:1184835019
Name:WALTER A. DEL GALLO, M.D.,P.A.
Entity Type:Organization
Organization Name:WALTER A. DEL GALLO, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEL GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-241-0324
Mailing Address - Street 1:14317 NW BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CRP CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:#204
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7129
Practice Address - Country:US
Practice Address - Phone:361-595-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0710332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1270070002Medicare ID - Type UnspecifiedPALMETTO SUPPLIER NUMBER