Healthcare Provider Details

I. General information

NPI: 1497730980
Provider Name (Legal Business Name): GERALD JOSEPH GALLINGHOUSE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 02/09/2022
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N IH 35 STE 700
AUSTIN TX
78705-1852
US

IV. Provider business mailing address

3000 N IH 35 STE 700
AUSTIN TX
78705-1852
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-3150
  • Fax: 512-458-7879
Mailing address:
  • Phone: 512-807-3150
  • Fax: 512-458-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberJ2573
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ2573
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: