Provider Demographics
NPI:1285721175
Name:GALLAGHER, EILEEN (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 UTE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7636
Mailing Address - Country:US
Mailing Address - Phone:435-602-0187
Mailing Address - Fax:435-355-3734
Practice Address - Street 1:1441 UTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7636
Practice Address - Country:US
Practice Address - Phone:435-602-0187
Practice Address - Fax:435-355-3734
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62729208000000X
UT9086607-1205208000000X
UT90866071205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics