Healthcare Provider Details

I. General information

NPI: 1073809778
Provider Name (Legal Business Name): JUAN JOSE GALLEGOS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIVLEY RD SW STE 300
HUNTSVILLE AL
35801-5102
US

IV. Provider business mailing address

PO BOX 040005
HUNTSVILLE AL
35804-4005
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-5594
  • Fax: 256-533-3379
Mailing address:
  • Phone: 256-533-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number46749
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: