Provider Demographics
NPI:1427163930
Name:GALLAGHER, JAMES JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:GALLAGHER
Suffix:
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 1:268 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3139
Mailing Address - Country:US
Mailing Address - Phone:831-728-0440
Mailing Address - Fax:831-728-4293
Practice Address - Street 1:268 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3139
Practice Address - Country:US
Practice Address - Phone:831-728-0440
Practice Address - Fax:831-728-4293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G529290Medicaid
A52386Medicare UPIN
00G529290Medicare ID - Type Unspecified