Provider Demographics
NPI:1922094465
Name:GALLO, RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:7457 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-547-4678
Practice Address - Fax:520-547-5691
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-12-03
Deactivation Date:2005-10-11
Deactivation Code:
Reactivation Date:2005-11-07
Provider Licenses
StateLicense IDTaxonomies
AZ33715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ939085Medicaid
AZZ116024OtherMEDICARE PTAN
AZI31153Medicare UPIN