Provider Demographics
NPI:1225667843
Name:GALLAGHER, JOHN HUNT III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUNT
Last Name:GALLAGHER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BAYVIEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1772
Mailing Address - Country:US
Mailing Address - Phone:954-567-1332
Mailing Address - Fax:
Practice Address - Street 1:3000 BAYVIEW DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1772
Practice Address - Country:US
Practice Address - Phone:954-567-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME167075208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program