Provider Demographics
NPI:1114913282
Name:GALLARDO, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 NW STEWART PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1203
Mailing Address - Country:US
Mailing Address - Phone:541-673-2267
Mailing Address - Fax:541-672-9483
Practice Address - Street 1:2880 NW STEWART PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1203
Practice Address - Country:US
Practice Address - Phone:541-673-2267
Practice Address - Fax:541-672-9483
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG775582085R0001X
ORMD2183902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G775582Medicare ID - Type Unspecified
G46410Medicare UPIN