Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35.130222 | OH |
Y | 111NI0900X | Internist | 35.130222 | OH |
N | 207R00000X | Internist | MD60310185 | WA |
N | 111NI0900X | Internist | MD60310185 | WA |
N | 207SG0201X | Clinical Genetics (M.D.) | MD60310185 | WA |
NPI | 1417161977 |
---|---|
Provider Name | Carlos J Gallego |
First Address | Miamisburg, OH 45342-6115 |
Second Address | Kettering, OH 45429-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0206321 | (05) | OH |
P01696169 | RR PTAN WVH (01) | WA |