Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5806630-1205 | UT |
Y | 111NI0900X | Internist | 5806630-1205 | UT |
N | 207RA0401X | Internist - Addiction Medicine | 5806630-1205 | UT |
NPI | 1992865273 |
---|---|
Provider Name | Ms. Christina Lynne Gallop |
First Address | Slc, UT 84103-2193 |
Second Address | Slc, UT 84148-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 09/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870569356018 | (05) | UT |
870569356021 | (05) | UT |
D6924 | (05) | UT |