Basic Information
Provider Information
NPI: 1881882439
EntityType: 2
ReplacementNPI:  
OrganizationName: GALLINAS EMERGENCY PHYSICIANS
LastName:  
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Mailing Information
Address1: PO BOX 42609
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191012609
CountryCode: US
TelephoneNumber: 8004447009
FaxNumber: 8003053233
Practice Location
Address1: 104 LEGION DR
Address2:  
City: LAS VEGAS
State: NM
PostalCode: 877014804
CountryCode: US
TelephoneNumber: 8003550808
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/09/2007
LastUpdateDate: 11/26/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BYRNE
AuthorizedOfficialFirstName: GREGORY
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8003550808
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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