Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 22340 | OK |
NPI | 1316987217 |
---|---|
Provider Name | John Ryan Gallagher |
First Address | Altus, OK 73521-1307 |
Second Address | Altus, OK 73521-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 13/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200089670A | (05) | OK |