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NPI Code Detail

MEDICARE: GRACIELA GALLARDO MD

MEDICARE:   GRACIELA  GALLARDO  MD
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
1207Q00000XFamily Medicine Physician25140OK

General Provider Information

NPI Number : 1639211261
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACIELA GALLARDO MD
Provider Business Mailing Address
First Line : 1701 RENAISSANCE BLVD
Second Line : SUITE 110
City : EDMOND
State : OK
Zip : 73013-3086
Country : US
Telephone Number : 405-844-4978
Fax Number : 405-844-0562
Provider Business Practice Location Address
First Line : 5101 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2018
Country : US
Telephone Number : 405-752-9600
Fax Number : 405-752-9650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 11/29/2016

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Directions to “ GRACIELA GALLARDO MD” Practice Location

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