Healthcare Provider Details

I. General information

NPI: 1831125657
Provider Name (Legal Business Name): STANLEY C GALLAGHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ORCHARD DR
SISSETON SD
57262-2312
US

IV. Provider business mailing address

205 ORCHARD DR
SISSETON SD
57262-2312
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7681
  • Fax: 605-698-3493
Mailing address:
  • Phone: 605-698-7681
  • Fax: 605-698-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3948
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23330
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3994
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: