Basic Information
| Provider Information | |||||||||
| NPI: | 1831391259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALDAMES | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | ALBERTO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 NW 82ND AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333247808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542557310 | ||||||||
| FaxNumber: | 9542551530 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NW 82ND AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542557310 | ||||||||
| FaxNumber: | 9542551530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | ME102537 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 90079 | 01 | FL | BCBS | OTHER | 000580100 | 05 | FL | MEDICAID |