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NPI Code Detail

MEDICARE: DR. MASHIRA DENISHA JACKSON-GALLEGOS MD

MEDICARE: DR. MASHIRA DENISHA JACKSON-GALLEGOS 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 Physician141452NC
2207Q00000XFamily Medicine PhysicianME 108584FL

Other Identifiers

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

General Provider Information

NPI Number : 1639373509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MASHIRA DENISHA JACKSON-GALLEGOS MD
Provider Business Mailing Address
First Line : 8751 N 30TH ST
Second Line :
City : TAMPA
State : FL
Zip : 33604-2213
Country : US
Telephone Number : 813-980-2422
Fax Number : 813-305-2642
Provider Business Practice Location Address
First Line : 8751 N 30TH ST
Second Line :
City : TAMPA
State : FL
Zip : 33604-2213
Country : US
Telephone Number : 813-980-2422
Fax Number : 813-305-2642
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 01/31/2025

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