MEDICARE: DR. JOHN PATRICK GALLAGHER II PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20040155A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104931708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK GALLAGHER II PH D

Provider Business Mailing Address
First Line	:	5524 S EMERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-2517
Country	:	US
Telephone Number	:	317-781-1917
Fax Number	:	317-781-8170

Provider Business Practice Location Address
First Line	:	5524 S EMERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-2517
Country	:	US
Telephone Number	:	317-781-1917
Fax Number	:	317-781-8170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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