Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001221 | MI |
N | 2081S0010X | Sports Medicine | 5901001221 | MI |
N | 213ES0000X | Sports Medicine | 5901001221 | MI |
N | 213ES0131X | Foot Surgery | 5901001221 | MI |
NPI | 1568467082 |
---|---|
Provider Name | James W Gallagher |
First Address | Marquette, MI 49855-2675 |
Second Address | Marquette, MI 49855-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 24/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5210682 | (05) | MI |
T34011 | (02) |