Provider Demographics
NPI:1659302099
Name:GALLARDO, MARK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:959 SUNLAND PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1323
Mailing Address - Country:US
Mailing Address - Phone:915-542-0279
Mailing Address - Fax:915-542-0156
Practice Address - Street 1:959 SUNLAND PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1323
Practice Address - Country:US
Practice Address - Phone:915-542-0279
Practice Address - Fax:915-542-0156
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM1100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0140316OtherDPS NUMBER
TXJ0140316OtherDPS NUMBER
TX8D8204Medicare ID - Type Unspecified