Healthcare Provider Details

I. General information

NPI: 1861012031
Provider Name (Legal Business Name): GALLAGHER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 UTE BLVD STE 220
PARK CITY UT
84098-7636
US

IV. Provider business mailing address

1441 UTE BLVD STE 220
PARK CITY UT
84098-7636
US

V. Phone/Fax

Practice location:
  • Phone: 435-602-0187
  • Fax: 435-355-3734
Mailing address:
  • Phone: 435-602-0187
  • Fax: 435-355-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EILEEN GALLAGHER
Title or Position: MANAGER
Credential: MD
Phone: 415-533-8138