Provider Demographics
NPI:1922381565
Name:GALLANT, BETH CARD (DO)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:CARD
Last Name:GALLANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:CARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3369 NE STEPHENS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1200
Mailing Address - Country:US
Mailing Address - Phone:541-677-6116
Mailing Address - Fax:541-957-5181
Practice Address - Street 1:3369 NE STEPHENS ST STE 100
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1200
Practice Address - Country:US
Practice Address - Phone:541-677-6116
Practice Address - Fax:541-957-5181
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO162858208000000X
FLOS11705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1447421250Medicaid