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NPI Code Detail

MEDICARE: MR. EDUARDO GALLARDO NP

MEDICARE: MR. EDUARDO GALLARDO NP
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
1363LF0000XFamily Nurse PractitionerRN229452GA

General Provider Information

NPI Number : 1144697251
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDUARDO GALLARDO NP
Provider Business Mailing Address
First Line : 9511 WEIDNER LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-4874
Country : US
Telephone Number : 956-640-5204
Fax Number :
Provider Business Practice Location Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2321
Fax Number : 706-428-2812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 08/24/2015

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