Healthcare Provider Details

I. General information

NPI: 1225158090
Provider Name (Legal Business Name): JULIO F GALLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BRICKELL AVE SUITE 300
MIAMI FL
33131-3425
US

IV. Provider business mailing address

325 HOLIDAY DR
HALLANDALE BEACH FL
33009-6517
US

V. Phone/Fax

Practice location:
  • Phone: 305-624-0009
  • Fax: 305-373-1175
Mailing address:
  • Phone: 305-467-5000
  • Fax: 305-373-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME61539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: