Provider Demographics
NPI:1477653293
Name:RYAN GALLAGHER PLLC
Entity Type:Organization
Organization Name:RYAN GALLAGHER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-379-9090
Mailing Address - Street 1:3216 N MAIN ST
Mailing Address - Street 2:3804 HERITAGE TRAIL ALTUS,OK. 73521
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1307
Mailing Address - Country:US
Mailing Address - Phone:580-379-9090
Mailing Address - Fax:580-379-9091
Practice Address - Street 1:3216 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1307
Practice Address - Country:US
Practice Address - Phone:580-379-9090
Practice Address - Fax:580-379-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22340207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200089670AMedicaid