Provider Demographics
NPI:1336226075
Name:GALLEGOS, MIGUEL LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:LORENZO
Last Name:GALLEGOS
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 1:8004 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7628
Mailing Address - Country:US
Mailing Address - Phone:505-924-2225
Mailing Address - Fax:
Practice Address - Street 1:8004 CONSTITUTION PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7628
Practice Address - Country:US
Practice Address - Phone:505-924-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-262208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG88984Medicare UPIN