Provider Demographics
NPI:1407896913
Name:GALLARDO, IGNACIO L (MD)
Entity type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:L
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 1:3637 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-491-1760
Mailing Address - Fax:910-491-1764
Practice Address - Street 1:3637 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-491-1760
Practice Address - Fax:910-491-1764
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76744207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254846100Medicaid
FL44376OtherBLUE CROSS BLUE SHIELD
FL44376YMedicare PIN
FL44376WMedicare PIN
FL254846100Medicaid