Provider Demographics
NPI:1114993656
Name:GALLEN, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:GALLEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2620 EAST BARNETT ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8383
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-5538
Practice Address - Street 1:691 MURPHY ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-789-6460
Practice Address - Fax:541-789-6461
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-10-05
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Provider Licenses
StateLicense IDTaxonomies
ORMD24846207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH67709Medicare UPIN