Provider Demographics
NPI:1073809778
Name:GALLEGOS, JUAN JOSE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:GALLEGOS
Suffix:JR
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:PO BOX 040005
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-4005
Mailing Address - Country:US
Mailing Address - Phone:256-533-3388
Mailing Address - Fax:
Practice Address - Street 1:201 SIVLEY RD SW STE 300
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5102
Practice Address - Country:US
Practice Address - Phone:256-536-5594
Practice Address - Fax:256-533-3379
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46749208G00000X
FLME133756208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty