Individual
DR. GWEN EILEEN FAGALA-BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 HARBORSIDE DR STE 118-119, GALVESTON, TX 77555-1990
(409) 772-0770
Mailing address
PO BOX 650859, DEPT. 710, DALLAS, TX 75265-0859
(409) 772-2222
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
H8027
TX
2084P0805X
Geriatric Psychiatry Physician
H8027
TX
Other
Enumeration date
03/23/2006
Last updated
01/09/2025
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