Provider Demographics
NPI:1508816752
Name:GALLEGO, MANUEL F (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:F
Last Name:GALLEGO
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 1:725 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8752
Mailing Address - Country:US
Mailing Address - Phone:863-494-1242
Mailing Address - Fax:963-491-0466
Practice Address - Street 1:725 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266
Practice Address - Country:US
Practice Address - Phone:863-494-1242
Practice Address - Fax:963-491-0466
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME761192084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44665OtherBCBS
FL255741000Medicaid
FLG71374Medicare UPIN