Provider Demographics
NPI:1336346485
Name:GALLEGO, SAMUEL G (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:G
Last Name:GALLEGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-682-9877
Mailing Address - Fax:305-682-1602
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:# 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-682-9877
Practice Address - Fax:305-682-1602
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2016-08-31
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Provider Licenses
StateLicense IDTaxonomies
FLME82380208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278545500Medicaid