MEDICARE: PETER L GALLARELLO DPM PLLC

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	213E00000X	Podiatrist	9901	NV

General Provider Information

NPI Number	:	1306192430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER L GALLARELLO DPM PLLC

Provider Business Mailing Address
First Line	:	PO BOX 26055
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-0055
Country	:	US
Telephone Number	:	702-791-3668
Fax Number	:	702-452-3668

Provider Business Practice Location Address
First Line	:	1703 CIVIC CENTER DR
Second Line	:	#3
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7212
Country	:	US
Telephone Number	:	702-791-3668
Fax Number	:	702-452-3668

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER L GALLARELLO
Credential	:	DPM
Telephone Number	:	702-791-3668

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	03/26/2013

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