Basic Information
| Provider Information | |||||||||
| NPI: | 1295712974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLANT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 W WHITE EAGLE RD | ||||||||
| Address2: | |||||||||
| City: | LEAF RIVER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610479733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402555421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 403 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610213116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152855552 | ||||||||
| FaxNumber: | 8152855865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 09/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036075586 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 036075586 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036075586 | 01 | IL | STATE LICENSE | OTHER | 036075586 | 05 | IL | MEDICAID |