Provider Demographics
NPI:1992866586
Name:GALLANIS, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:GALLANIS
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 1:3316 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4565
Mailing Address - Country:US
Mailing Address - Phone:206-362-5100
Mailing Address - Fax:206-362-5102
Practice Address - Street 1:3316 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4565
Practice Address - Country:US
Practice Address - Phone:206-362-5100
Practice Address - Fax:206-362-5102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151880OtherLABOR AND INDUSTRIES
WA107556OtherAETNA
WA6300GAOtherREGENCE RIDER NUMBER
WA1114917Medicaid
WA1114917Medicaid
WA6300GAOtherREGENCE RIDER NUMBER