Healthcare Provider Details

I. General information

NPI: 1689053118
Provider Name (Legal Business Name): BILLY J GALLIGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N WHITLEY DR
FRUITLAND ID
83619-2434
US

IV. Provider business mailing address

660 E FRANKLIN RD STE 140
MERIDIAN ID
83642-2914
US

V. Phone/Fax

Practice location:
  • Phone: 208-452-2672
  • Fax: 208-452-2673
Mailing address:
  • Phone: 208-452-2672
  • Fax: 208-452-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMRM-1473
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberM-13499
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: