Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MRM-1473 | ID |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | M-13499 | ID |
NPI | 1689053118 |
---|---|
Provider Name | Billy Galligar |
First Address | Boise, ID 83704-9251 |
Second Address | Fruitland, ID 83619-5040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2015 |
Last Update Date | 29/08/2019 |