Provider Demographics
NPI:1184708257
Name:GALSTER, ALLEN D (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:D
Last Name:GALSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3253
Mailing Address - Country:US
Mailing Address - Phone:707-473-4404
Mailing Address - Fax:707-473-4405
Practice Address - Street 1:1540 HEALDSBURG AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3253
Practice Address - Country:US
Practice Address - Phone:707-473-4404
Practice Address - Fax:707-473-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36691208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G366910Medicaid
F14466Medicare UPIN
00G366910Medicare ID - Type Unspecified