Provider Demographics
NPI:1730123589
Name:GALLAGHER, PETER L (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:GALLAGHER
Suffix:
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:PO BOX 6607
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0607
Mailing Address - Country:US
Mailing Address - Phone:402-483-3333
Mailing Address - Fax:
Practice Address - Street 1:1600 S 48TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1274
Practice Address - Country:US
Practice Address - Phone:402-483-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24575207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592302Medicaid
KY060063759OtherRAILROAD MEDICARE
NE10026072400Medicaid
NE10026072500Medicaid
KS200567010AMedicaid
NE47070592301Medicaid
NE47070592306Medicaid
NE47070592300Medicaid
NE47070592313Medicaid
KY6403181800Medicaid
IA0401411Medicaid
NE10026072300Medicaid
NE47070592305Medicaid
NE10026072000Medicaid
NE10026072200Medicaid
NE10026072600Medicaid
KY6403181800Medicaid
NE47070592313Medicaid
KY0212416Medicare PIN
NE10026072300Medicaid
NE10026072600Medicaid
IA0401411Medicaid
NE098570003Medicare PIN