Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN12993 | FL |
NPI | 1134250020 |
---|---|
Provider Name | Dr. John Paul Gallardo |
First Address | Miami, FL 33145-2541 |
Second Address | Miami, FL 33145-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |