Provider Demographics
NPI:1932291499
Name:MAGALLAN, ALBERT JR
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:MAGALLAN
Suffix:JR
Gender:M
Credentials:
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 1137
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505
Mailing Address - Country:US
Mailing Address - Phone:956-687-7572
Mailing Address - Fax:956-687-2726
Practice Address - Street 1:1231 E HACKBERRY
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-687-7527
Practice Address - Fax:956-687-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXD0013644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies