Provider Demographics
NPI:1295794188
Name:GALLARDO, SALVADOR A (MD)
Entity type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:A
Last Name:GALLARDO
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 1:1425 S US 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5141
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:352-793-8050
Practice Address - Street 1:7205 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2105
Practice Address - Country:US
Practice Address - Phone:352-680-0324
Practice Address - Fax:352-680-0173
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89290208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53009OtherBCBS FL
FL273832500Medicaid
FLP00707508OtherRR MEDICARE
FLU6259VMedicare PIN
FLU6259WMedicare PIN
FLU6259XMedicare PIN
FLU6259UMedicare PIN
FL53009OtherBCBS FL
FLU6259YMedicare PIN
FLU6259TMedicare PIN