Healthcare Provider Details

I. General information

NPI: 1477653293
Provider Name (Legal Business Name): RYAN GALLAGHER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 N MAIN ST
ALTUS OK
73521-1307
US

IV. Provider business mailing address

3216 N MAIN ST 3804 HERITAGE TRAIL ALTUS,OK. 73521
ALTUS OK
73521-1307
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-9090
  • Fax: 580-379-9091
Mailing address:
  • Phone: 580-379-9090
  • Fax: 580-379-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number22340
License Number StateOK

VIII. Authorized Official

Name: DR. RYAN GALLAGHER
Title or Position: ORTHOPEDIC SURGEON
Credential: M.D.
Phone: 580-379-9090