Healthcare Provider Details

I. General information

NPI: 1073803276
Provider Name (Legal Business Name): SAMUEL E. GALLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE STE H220
KIRKLAND WA
98034-3064
US

IV. Provider business mailing address

12911 120TH AVE NE STE H220
KIRKLAND WA
98034-3064
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-4224
  • Fax:
Mailing address:
  • Phone: 425-823-4224
  • Fax: 425-820-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD61019703
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD61019703
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: