Provider Demographics
NPI:1932137767
Name:GALLAGHER, KEVIN M (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:M
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:512-206-4341
Mailing Address - Fax:512-407-1947
Practice Address - Street 1:205 W WINDCREST ST
Practice Address - Street 2:STE 230 AUSTIN HEART
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4479
Practice Address - Country:US
Practice Address - Phone:830-990-9994
Practice Address - Fax:830-990-9763
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6387207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1593980-02Medicaid
TXH87530Medicare UPIN
TX8J2588Medicare PIN
TX8A8604Medicare PIN