Provider Demographics
NPI:1043589245
Name:GALLARDO, JOE III (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:GALLARDO
Suffix:III
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 555657
Mailing Address - Street 2:1ST MEDICAL BATTALION
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5657
Mailing Address - Country:US
Mailing Address - Phone:760-725-3784
Mailing Address - Fax:
Practice Address - Street 1:22 AREA REGIMENTAL AID STATION
Practice Address - Street 2:1ST MEDICAL BATTALION
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5657
Practice Address - Country:US
Practice Address - Phone:760-725-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman