Provider Demographics
NPI:1457566705
Name:GALLAGHER, JIMMY COURSEN
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:COURSEN
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3228
Mailing Address - Country:US
Mailing Address - Phone:432-212-4935
Mailing Address - Fax:888-758-0672
Practice Address - Street 1:5006 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3228
Practice Address - Country:US
Practice Address - Phone:432-212-4935
Practice Address - Fax:888-758-0672
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3563052471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography