Provider Demographics
NPI:1003268566
Name:GALLIP, JOHN ROBERT (EMT, NAR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GALLIP
Suffix:
Gender:M
Credentials:EMT, NAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 DAVIS AVE S APT G201
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6288
Mailing Address - Country:US
Mailing Address - Phone:978-339-3535
Mailing Address - Fax:
Practice Address - Street 1:4600 DAVIS AVE S APT G201
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6288
Practice Address - Country:US
Practice Address - Phone:978-339-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60554096146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic