Provider Demographics
NPI:1891115614
Name:GALVAN, EDWARD (NP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GALVAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-7205
Mailing Address - Country:US
Mailing Address - Phone:817-566-0478
Mailing Address - Fax:817-566-0484
Practice Address - Street 1:5750 PINELAND DR # 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5300
Practice Address - Country:US
Practice Address - Phone:469-637-4204
Practice Address - Fax:214-221-1437
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-19
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily