Provider Demographics
NPI:1316935323
Name:GALLEY, RAYMOND C (PA-C)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:GALLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 GALISTEO ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4752
Mailing Address - Country:US
Mailing Address - Phone:505-820-9870
Mailing Address - Fax:505-983-1265
Practice Address - Street 1:1651 GALISTEO ST STE 8
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4752
Practice Address - Country:US
Practice Address - Phone:505-820-9870
Practice Address - Fax:505-983-1265
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84PA004363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84-PA004OtherPHYSICIANS ASSISTANT CERTIFICATE
NME0665Medicaid
NME0665Medicaid
NM349327201Medicare ID - Type Unspecified
NMP93507Medicare UPIN