Provider Demographics
NPI:1861752214
Name:GALVESTON PHYSICAL MEDICINE PLLC
Entity type:Organization
Organization Name:GALVESTON PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-744-9355
Mailing Address - Street 1:2724 61ST ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-8137
Mailing Address - Country:US
Mailing Address - Phone:409-744-9355
Mailing Address - Fax:409-744-9356
Practice Address - Street 1:2724 61ST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-8137
Practice Address - Country:US
Practice Address - Phone:409-744-9355
Practice Address - Fax:409-744-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6712500001Medicare NSC
TX270556Medicare PIN
TXTXB162736Medicare PIN