Provider Demographics
NPI:1992721880
Name:GALLAHER, REGAN S (MD)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:S
Last Name:GALLAHER
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:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-932-0352
Mailing Address - Fax:501-932-0354
Practice Address - Street 1:2200 ADA AVE STE 302A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4985
Practice Address - Country:US
Practice Address - Phone:501-932-0352
Practice Address - Fax:501-932-0354
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3374207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M327OtherAR BC/BS
AR149280001Medicaid
ARP00301757OtherRR MCR
ARP00301757OtherRR MCR
ARP00301757OtherRR MCR
AR149280001Medicaid