Provider Demographics
NPI:1023397288
Name:GALLO, STACY MARTYN (PA -C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARTYN
Last Name:GALLO
Suffix:
Gender:F
Credentials:PA -C
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Mailing Address - Street 1:402 BLUFFCOURT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1907
Mailing Address - Country:US
Mailing Address - Phone:210-378-5555
Mailing Address - Fax:210-378-5555
Practice Address - Street 1:1380 PANTHEON WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2288
Practice Address - Country:US
Practice Address - Phone:210-404-9696
Practice Address - Fax:210-404-9466
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2013-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical