Provider Demographics
NPI:1366497133
Name:GALLOPS, CECIL WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:WAYNE
Last Name:GALLOPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1804
Mailing Address - Country:US
Mailing Address - Phone:309-281-7065
Mailing Address - Fax:
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-792-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082049207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE70596OtherBLUE CROSS BLUE SHIELD
930010658OtherRAILROAD MEDICARE
054320OtherHEALTH ALLIANCE
IL41053Medicaid
E70596OtherTRICARE
IA96928OtherBLUE CROSS BLUE SHIELD
239407OtherMIDLANDS CHOICE
E70596Medicare UPIN