Provider Demographics
NPI:1093001323
Name:WALKER GALLEGO, EDWARD RANDAL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RANDAL
Last Name:WALKER GALLEGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4601 PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2290
Mailing Address - Country:US
Mailing Address - Phone:704-323-2248
Mailing Address - Fax:
Practice Address - Street 1:441 MCALISTER RD STE 1100A
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4127
Practice Address - Country:US
Practice Address - Phone:704-732-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6586207X00000X
NC2021-01484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty