Provider Demographics
NPI:1437316890
Name:GALO CONSTANTE MD PA
Entity Type:Organization
Organization Name:GALO CONSTANTE MD PA
Other - Org Name:CONSTANTE FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALO
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONSTANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-275-9040
Mailing Address - Street 1:PO BOX 60533
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6533
Mailing Address - Country:US
Mailing Address - Phone:239-275-9040
Mailing Address - Fax:239-275-9070
Practice Address - Street 1:12400 BRANTLEY COMMONS CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5663
Practice Address - Country:US
Practice Address - Phone:239-275-9040
Practice Address - Fax:239-275-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP03000075881261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care