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NPI Code Detail

MEDICARE: JEROME GALLIEN M.D.

MEDICARE: JEROME GALLIEN 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
12085R0202XDiagnostic Radiology Physician016193LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417941162
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME GALLIEN M.D.
Provider Business Mailing Address
First Line : PO BOX 1128
Second Line :
City : JENNINGS
State : LA
Zip : 70546-1128
Country : US
Telephone Number : 337-824-4403
Fax Number : 337-824-9731
Provider Business Practice Location Address
First Line : 1634 ELTON RD
Second Line :
City : JENNINGS
State : LA
Zip : 70546-3614
Country : US
Telephone Number : 337-616-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 10/08/2014

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