Provider Demographics
NPI:1043604945
Name:GALLAGHER, THOMAS MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MITCHELL
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 17TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1736
Mailing Address - Country:US
Mailing Address - Phone:406-245-3238
Mailing Address - Fax:406-248-6814
Practice Address - Street 1:2510 17TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1736
Practice Address - Country:US
Practice Address - Phone:406-245-3238
Practice Address - Fax:406-248-6814
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-959522086S0122X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery