Organization · NPI-2

Jonathan P Walgama MD PA

Ophthalmology · Longview, TX

NPI number1487184867
StatusActive
Last updated in NPPESJun 21, 2022

Details

NPI
1487184867
Entity type
Organization (NPI-2)
Legal business name
Jonathan P Walgama MD PA
Organization subpart
No
Enumeration date
Jun 18, 2017
Certification date
Jun 21, 2022
Last updated
Jun 21, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207W00000X OphthalmologyQ3122TXYes

Practice location

3209 4th St Ste 100
Longview, TX 75605-5170

Phone 903-757-2020 · Fax 903-465-4665

Mailing address

3209 4th St Ste 100
Longview, TX 75605-5170

Authorized official

Norberto Hernandez
Office Manager
9037572020

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