Provider Demographics
NPI:1013960830
Name:GALLEGO, RAMON E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:E
Last Name:GALLEGO
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 1:1874 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1417
Mailing Address - Country:US
Mailing Address - Phone:954-360-9582
Mailing Address - Fax:954-426-4533
Practice Address - Street 1:1874 W HILLSBORO BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1417
Practice Address - Country:US
Practice Address - Phone:954-360-9582
Practice Address - Fax:954-426-4533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32716207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME32716OtherMEDICAL LISC
FLD66085Medicare UPIN
FL92777Medicare ID - Type UnspecifiedMEDICARE NUMBER