Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH10796 | FL |
NPI | 1366788853 |
---|---|
Provider Name | Dr. Mark Gallant |
First Address | Dunedin, FL 34698-5756 |
Second Address | Dunedin, FL 34698-5756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2013 |
Last Update Date | 10/10/2013 |