Basic Information
| Provider Information | |||||||||
| NPI: | 1992865273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLOP | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 662 N CORTEZ ST | ||||||||
| Address2: | |||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841032193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019494538 | ||||||||
| FaxNumber: | 8015842509 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 FOOTHILL DR | ||||||||
| Address2: | |||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841482201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019494538 | ||||||||
| FaxNumber: | 8015842509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2006 | ||||||||
| LastUpdateDate: | 05/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 5806630-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207R00000X | 5806630-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 870569356018 | 05 | UT | MEDICAID | D6924 | 05 | UT | MEDICAID | 870569356021 | 05 | UT | MEDICAID |