Healthcare Provider Details

I. General information

NPI: 1528315066
Provider Name (Legal Business Name): W H GALLIMORE DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 AVENUE H
ELY NV
89301-2615
US

IV. Provider business mailing address

3196 WILLOW CREEK RD STE A103 BOX 245
PRESCOTT AZ
86301-6689
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO
License Number StateNV

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799