Organization
JONATHAN P WALGAMA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORBERTO HERNANDEZ (OFFICE MANAGER)
(903) 757-2020
Entity
Organization
Contact information
Practice address
3209 4TH ST STE 100, LONGVIEW, TX 75605-5170
(903) 757-2020
(903) 465-4665
Mailing address
3209 4TH ST STE 100, LONGVIEW, TX 75605-5170
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
Q3122
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346191501
—
TX
01
—
8FF527
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/18/2017
Last updated
06/21/2022
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