Provider Demographics
NPI:1487648143
Name:GALLAGHER, JAMES LAWRENCE (MD FAPA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 73RD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1321
Mailing Address - Country:US
Mailing Address - Phone:515-222-1175
Mailing Address - Fax:515-222-0953
Practice Address - Street 1:1000 73RD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1321
Practice Address - Country:US
Practice Address - Phone:515-222-1175
Practice Address - Fax:515-222-0953
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA236102084F0202X, 2084P0800X
NC206012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20562OtherWELLMARK
IA20562OtherWELLMARK
A02224Medicare UPIN