=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831125657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY C GALLAGHER DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 ORCHARD DR
-----------------------------------------------------
City | SISSETON
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57262-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-698-7681
-----------------------------------------------------
Fax | 605-698-3493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 ORCHARD DR
-----------------------------------------------------
City | SISSETON
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57262-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-698-7681
-----------------------------------------------------
Fax | 605-698-3493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3948
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23330
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3994
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------