Provider Demographics
NPI:1316642853
Name:GALLIGAN-CAMPBELL, MADISON (DO)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:GALLIGAN-CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:GALLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2317 TIMSBURY WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1209
Mailing Address - Country:US
Mailing Address - Phone:714-616-7734
Mailing Address - Fax:
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:805-739-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA20A23171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program