Provider Demographics
NPI:1942246350
Name:GALLAGHER, MITCHELL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:EDWARD
Last Name:GALLAGHER
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 1:5618 BILLY CASPER DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1027
Mailing Address - Country:US
Mailing Address - Phone:406-237-5862
Mailing Address - Fax:406-238-6068
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 210W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-237-5862
Practice Address - Fax:406-238-6068
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT48892085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT96110OtherBLUE CROSS BLUE SHIELD
MT77402Medicaid
MT9611Medicare ID - Type Unspecified
MT77402Medicaid