Healthcare Provider Details

I. General information

NPI: 1508062522
Provider Name (Legal Business Name): ROBERT JOSEPH GALLAGHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N
PARRISH FL
34219-8410
US

IV. Provider business mailing address

PO BOX 997
PALMETTO FL
34220-0997
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4000
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: