Provider Demographics
NPI:1992865273
Name:GALLOP, CHRISTINA LYNNE (MD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LYNNE
Last Name:GALLOP
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 1:662 N CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2193
Mailing Address - Country:US
Mailing Address - Phone:801-949-4538
Mailing Address - Fax:801-584-2509
Practice Address - Street 1:5235 HHR RANCH RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9210
Practice Address - Country:US
Practice Address - Phone:307-739-7696
Practice Address - Fax:307-739-4877
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16009A207R00000X
UT5806630-1205207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6924Medicaid
UT870569356018Medicaid
WY227667400Medicaid
UT870569356021Medicaid