Provider Demographics
NPI:1710990189
Name:GALE, JOHN GODDARD JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GODDARD
Last Name:GALE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 SW SCOFFINS ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6226
Mailing Address - Country:US
Mailing Address - Phone:503-626-1464
Mailing Address - Fax:
Practice Address - Street 1:8770 SW SCOFFINS ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6226
Practice Address - Country:US
Practice Address - Phone:503-684-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 140652084P0800X
WA000346322084P0800X
ORMD140652084P0804X
WAMD000346322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry