Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME133756 | FL |
NPI | 1073809778 |
---|---|
Provider Name | Dr. Juan Jose Gallegos JR. |
First Address | Tallahassee, FL 32308-4663 |
Second Address | Tallahassee, FL 32308-4663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 29/07/2019 |