Provider Demographics
NPI:1235768219
Name:GALLIOSBORN, CHRISTOPHER DEAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DEAN
Last Name:GALLIOSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:DEAN
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:818-993-4054
Mailing Address - Fax:
Practice Address - Street 1:9450 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5555
Practice Address - Country:US
Practice Address - Phone:801-576-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13385320-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty