Provider Demographics
NPI:1700828431
Name:GALLUPE, DEAN RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RONALD
Last Name:GALLUPE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4644 KEYSVILLE AVE.
Mailing Address - Street 2:HOSPICE&PALLIATIVE PHYSICIAN SERVICES, LLC
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608
Mailing Address - Country:US
Mailing Address - Phone:352-650-2250
Mailing Address - Fax:
Practice Address - Street 1:4644 KEYSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3515
Practice Address - Country:US
Practice Address - Phone:352-650-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004411207Q00000X
VA0102203688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
261083931OtherTAX ID
C10361OtherGROUP ORGANIZATION PTAN
DN2980OtherGROUP PTAN
FL265483100Medicaid
P01309377OtherPTAN
VA1700828431Medicaid
FL82466Medicare ID - Type Unspecified
FLD60647Medicare UPIN