Basic Information
| Provider Information | |||||||||
| NPI: | 1568720779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLEGO | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128780 | ||||||||
| FaxNumber: | 3182126752 | ||||||||
| Practice Location | |||||||||
| Address1: | 8001 YOUREE DR | ||||||||
| Address2: | SUITE 880 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711152302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123821 | ||||||||
| FaxNumber: | 3182123825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD.208256 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.