Healthcare Provider Details

I. General information

NPI: 1477536100
Provider Name (Legal Business Name): CATHERINE JANE GALLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74B CENTENNIAL LOOP SUITE 100
EUGENE OR
97401-7919
US

IV. Provider business mailing address

74B CENTENNIAL LOOP SUITE 100
EUGENE OR
97401-7919
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-3791
  • Fax: 541-686-3795
Mailing address:
  • Phone: 541-686-3791
  • Fax: 541-686-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD15394
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier167528
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: