Organization
A. B. DEGALA, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO BANZON DEGALA M.D. (OWNER)
(319) 524-8211
Entity
Organization
Contact information
Practice address
1603 MORGAN ST, SUITE 5, KEOKUK, IA 52632-3433
(319) 524-8211
Mailing address
1603 MORGAN ST, SUITE 5, KEOKUK, IA 52632-3433
(319) 524-8211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073981
—
IA
01
—
07398
BLUE CROSS BLUE SHIELD
IA
01
—
1598768863
NPI
IA
Enumeration date
02/01/2007
Last updated
05/09/2008
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