Provider Demographics
NPI:1851327621
Name:GALLEGOS, JESUS S (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:S
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 CENTERVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1440
Mailing Address - Country:US
Mailing Address - Phone:210-280-0040
Mailing Address - Fax:210-280-0060
Practice Address - Street 1:4438 CENTERVIEW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1440
Practice Address - Country:US
Practice Address - Phone:210-280-0040
Practice Address - Fax:210-280-0060
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151032OtherWELLMED MEDICARE
TX181664701Medicaid
TX181664703OtherWELLMED MEDICAID
TXI58795Medicare UPIN