Basic Information
| Provider Information | |||||||||
| NPI: | 1215094040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | TIMOTHY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2049 PEPPER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711159412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187987077 | ||||||||
| FaxNumber: | 3187987077 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 BERT KOUNS INDUSTRIAL LOOP | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182125500 | ||||||||
| FaxNumber: | 3182125358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.016829 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 016829 | 01 | LA | STATE LICENSE | OTHER | 1344231 | 05 | LA | MEDICAID |