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General NPI Number Information
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NPI Number | 1366825234
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Entity Type | Individual
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Provider Name | MARIAM GALLAGHER DO
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Gender | Female
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 2055 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5014
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Country | US
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Telephone | 818-624-4536
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 KIMBALL AVE STE 201
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City | WATERLOO
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State | IA
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Zip | 50702-5047
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Country | US
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Telephone | 818-624-4536
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S6840
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5940
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0097R
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-05933
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License Number State | IA
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