Organization
GALLEGO HEALTH
Active
Organization
GALLEGO HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR GALLEGO MD (PRESIDENT)
(318) 773-0657
Entity
Organization
Contact information
Practice address
115 HALLETTE DR, SHREVEPORT, LA 71115-2959
(318) 773-0657
(318) 688-1559
Mailing address
PO BOX 19284, SHREVEPORT, LA 71149-0284
(318) 773-0657
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
208256
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208256
MEDICAL LICENSE
LA
Enumeration date
11/30/2017
Last updated
11/30/2017
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