Healthcare Provider Details

I. General information

NPI: 1114913282
Provider Name (Legal Business Name): DAVID GALLARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 E BARNETT RD
MEDFORD OR
97504-8301
US

IV. Provider business mailing address

2825 E BARNETT RD # MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4673
  • Fax:
Mailing address:
  • Phone: 541-789-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG77558
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD218390
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: