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General NPI Number Information
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NPI Number | 1043212640
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Entity Type | Individual
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Provider Name | JORGE GALLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 1600 S ANDREWS AVE PHOENIX OB/GYN, LLC
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2510
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Country | US
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Telephone | 954-355-5110
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Fax | 954-355-4919
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Provider Business Mailing Address
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Address Line | 1600 S. ANDREWS AVENUE SUITE 323 WEST WING
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316
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Country | US
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Telephone | 954-355-5110
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Fax | 954-355-4919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME58146
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License Number State | FL
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