MEDICARE: CLIFFORD M GALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	04 23541	KS
2	207T00000X	Neurological Surgery Physician	MD R4P55	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17554034	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1003817404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD M GALL M.D.

Provider Business Mailing Address
First Line	:	2609 GLENN HENDREN DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3313
Country	:	US
Telephone Number	:	816-781-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 GLENN HENDREN DR STE 108
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3388
Country	:	US
Telephone Number	:	816-781-3515
Fax Number	:	816-781-3517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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Directions to “ CLIFFORD M GALL M.D.” Practice Location

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