Provider Demographics
NPI:1770641706
Name:DRIGALLA, JESSICA WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:WALLACE
Last Name:DRIGALLA
Suffix:
Gender:F
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-248-8800
Mailing Address - Fax:
Practice Address - Street 1:2401 S. 31ST STREET
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508
Practice Address - Country:US
Practice Address - Phone:254-724-4363
Practice Address - Fax:254-724-1938
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics