Provider Demographics
NPI:1588645873
Name:GALLAHER, LORI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2812 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5715
Practice Address - Country:US
Practice Address - Phone:318-528-3355
Practice Address - Fax:318-528-3356
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA080187867OtherRAILROAD MEDICARE
LA1578576Medicaid
LA1578576Medicaid
LA4E462Medicare PIN
LA080187867OtherRAILROAD MEDICARE