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General NPI Number Information
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NPI Number | 1710963129
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Entity Type | Individual
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Provider Name | JUDITH SPRING GALLAGHER P.A.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2957 NW 27TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-2040
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Country | US
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Telephone | 954-730-2333
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Fax | 954-730-2337
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Provider Business Mailing Address
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Address Line | PO BOX 2277
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2277
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Country | US
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Telephone | 954-581-5206
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Fax | 954-730-2337
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101225
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License Number State | FL
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