Provider Demographics
NPI:1629048533
Name:GALLE, TODD (DPM)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:GALLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW HALL BVLD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5843
Mailing Address - Country:US
Mailing Address - Phone:503-245-2420
Mailing Address - Fax:503-245-2445
Practice Address - Street 1:9900 SW HALL BVLD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5843
Practice Address - Country:US
Practice Address - Phone:503-245-2420
Practice Address - Fax:503-245-2445
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0511213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43967Medicare UPIN
28074Medicare ID - Type Unspecified