Provider Demographics
NPI:1912124777
Name:TOM GALLAHER MD PLLC
Entity type:Organization
Organization Name:TOM GALLAHER MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:T
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-671-3888
Mailing Address - Street 1:7560 DANNAHER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4036
Mailing Address - Country:US
Mailing Address - Phone:865-671-3888
Mailing Address - Fax:865-679-4911
Practice Address - Street 1:7560 DANNAHER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4036
Practice Address - Country:US
Practice Address - Phone:865-671-3888
Practice Address - Fax:865-679-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35852174400000X
174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3289002Medicare PIN
TNF84980Medicare UPIN