Provider Demographics
NPI:1194859454
Name:GALLANT, ANDREW S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:GALLANT
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 1:1615 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9629
Mailing Address - Country:US
Mailing Address - Phone:772-878-5858
Mailing Address - Fax:772-692-2480
Practice Address - Street 1:1615 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9629
Practice Address - Country:US
Practice Address - Phone:772-878-5858
Practice Address - Fax:772-692-2480
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2654385 00Medicaid
FLV2628OtherBCBS#
FLE7087Medicare ID - Type Unspecified
FL2654385 00Medicaid