Provider Demographics
NPI:1477500791
Name:GALLOGLY, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:GALLOGLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3399 PGA BLVD.
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-624-0099
Mailing Address - Fax:561-624-7373
Practice Address - Street 1:3399 PGA BLVD.
Practice Address - Street 2:SUITE 350
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-624-0099
Practice Address - Fax:561-624-7373
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95642207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275937300Medicaid
I71675Medicare UPIN
FLAH986Medicare PIN