Provider Demographics
NPI:1609974484
Name:GALLAGHER, MARY SHANNON
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SHANNON
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SHANNON
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7711 LOUIS PASTEUR
Mailing Address - Street 2:#200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-692-9500
Mailing Address - Fax:210-616-9300
Practice Address - Street 1:7711 LOUIS PASTEUR
Practice Address - Street 2:#200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-692-9500
Practice Address - Fax:210-616-9300
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8542207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044516501Medicaid
TX044516501Medicaid
TXG72129Medicare UPIN