Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2101 | FL |
Y | 222Z00000X | Podiatrist | PO2101 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO2101 | FL |
N | 111NR0200X | Radiology | PO2101 | FL |
N | 213ER0200X | Radiology | PO2101 | FL |
N | 213ES0131X | Foot Surgery | PO2101 | FL |
NPI | 1013042167 |
---|---|
Provider Name | Dr. Jon B Gallinatti |
First Address | Hialeah, FL 33015 |
Second Address | Hialeah, FL 33015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 15/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390038000 | (05) | FL |
65204 | BCBS (01) | FL |
U22786 | (02) | FL |