Provider Demographics
NPI:1760477707
Name:GALLAHER, TOM TRACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:TRACEY
Last Name:GALLAHER
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 1:7560 DANNAHER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4038
Mailing Address - Country:US
Mailing Address - Phone:865-671-3888
Mailing Address - Fax:865-671-4911
Practice Address - Street 1:7560 DANNAHER DR STE 150
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4038
Practice Address - Country:US
Practice Address - Phone:865-671-3888
Practice Address - Fax:865-671-4911
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35852174400000X
TN358522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000222Medicaid