Provider Demographics
NPI:1891975983
Name:GALLAGHER, ERIC SHANNON
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SHANNON
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KENSINGTON DR
Mailing Address - Street 2:APT 923
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7162
Mailing Address - Country:US
Mailing Address - Phone:910-450-9581
Mailing Address - Fax:
Practice Address - Street 1:900 KENSINGTON DR
Practice Address - Street 2:APT 923
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7162
Practice Address - Country:US
Practice Address - Phone:910-450-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman