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General NPI Number Information
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NPI Number | 1316987217
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Entity Type | Individual
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Provider Name | JOHN RYAN GALLAGHER MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 3216 N MAIN ST
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City | ALTUS
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State | OK
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Zip | 73521-1307
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Country | US
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Telephone | 580-379-9090
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Fax | 580-379-9091
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Provider Business Mailing Address
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Address Line | 3216 N MAIN ST
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City | ALTUS
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State | OK
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Zip | 73521-1307
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Country | US
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Telephone | 580-379-9090
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Fax | 580-379-9091
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 22340
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License Number State | OK
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