Healthcare Provider Details

I. General information

NPI: 1568467082
Provider Name (Legal Business Name): JAMES W GALLAGHER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVE SUITE 190
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1321
  • Fax: 906-228-9371
Mailing address:
  • Phone: 906-225-1321
  • Fax: 906-228-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901001221
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number5901001221
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: