Provider Demographics
NPI:1710963129
Name:GALLAGHER, JUDITH SPRING (PA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SPRING
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2277
Mailing Address - Country:US
Mailing Address - Phone:954-581-5206
Mailing Address - Fax:954-730-2337
Practice Address - Street 1:2957 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-2040
Practice Address - Country:US
Practice Address - Phone:954-730-2333
Practice Address - Fax:954-730-2337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6370Medicare PIN