Healthcare Provider Details

I. General information

NPI: 1114993656
Provider Name (Legal Business Name): JOHN THOMAS GALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 MURPHY ROAD SUITE 107
MEDFORD OR
97504
US

IV. Provider business mailing address

2620 EAST BARNETT ROAD SUITE H
MEDFORD OR
97504-8383
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-6460
  • Fax: 541-789-6461
Mailing address:
  • Phone: 541-789-4281
  • Fax: 541-789-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD24846
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: