Provider Demographics
NPI:1427010461
Name:GALLUP, STEVEN B (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:B
Last Name:GALLUP
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 1:351 WEST CENTER ST.
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540
Mailing Address - Country:US
Mailing Address - Phone:919-577-6900
Mailing Address - Fax:919-577-2228
Practice Address - Street 1:351 WEST CENTER ST.
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-577-6900
Practice Address - Fax:919-577-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2215675BOtherMEDICARE ID
NC89013M8Medicaid
G09214Medicare UPIN