Provider Demographics
NPI:1255322871
Name:GAGLIANO, ROBERT GARY (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GARY
Last Name:GAGLIANO
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 1:203 S CANDY LN
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-639-6299
Mailing Address - Fax:928-639-6292
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:SUITE 9A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-639-6299
Practice Address - Fax:928-639-6292
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25096207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394370Medicare ID - Type Unspecified
C96054Medicare UPIN
AZMD25096Medicare ID - Type Unspecified