Provider Demographics
NPI:1487667184
Name:GALLAS, MENNEN T (MD)
Entity Type:Individual
Prefix:
First Name:MENNEN
Middle Name:T
Last Name:GALLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S FRY RD
Mailing Address - Street 2:STE 102
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-646-1114
Mailing Address - Fax:281-646-1138
Practice Address - Street 1:777 S FRY RD
Practice Address - Street 2:STE 102
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-646-1114
Practice Address - Fax:281-646-1138
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5105208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1300203OtherVHC
0085DYOtherBCBS
27688OtherAETNA
27688OtherAETNA
G77887Medicare UPIN