MEDICARE: BENITO GALLARDO M.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	2083X0100X	Occupational Medicine Physician	89-197	NM

General Provider Information

NPI Number	:	1437278447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITO GALLARDO M.D.

Provider Business Mailing Address
First Line	:	2445 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5049
Country	:	US
Telephone Number	:	575-521-1919
Fax Number	:	575-521-1676

Provider Business Practice Location Address
First Line	:	2445 S TELSHOR BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5049
Country	:	US
Telephone Number	:	505-521-0793
Fax Number	:	505-532-1607

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	05/28/2026

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