Provider Demographics
NPI:1487945879
Name:MENNEN T. GALLAS, MD PA
Entity type:Organization
Organization Name:MENNEN T. GALLAS, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MENNEN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:GALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-646-1114
Mailing Address - Street 1:21300 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-646-1114
Mailing Address - Fax:281-646-1138
Practice Address - Street 1:21300 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-646-1114
Practice Address - Fax:281-646-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5105208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00646JMedicare PIN
TXG77887Medicare UPIN