Provider Demographics
NPI:1053476226
Name:GALLOGLY, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:GALLOGLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6134
Mailing Address - Country:US
Mailing Address - Phone:352-392-1049
Mailing Address - Fax:352-392-2991
Practice Address - Street 1:1026 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6134
Practice Address - Country:US
Practice Address - Phone:352-392-1049
Practice Address - Fax:352-392-2991
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50430OtherBLUE CROSS BLUE SHIELD
FL50430ZMedicare NSC
FLI23848Medicare UPIN