Provider Demographics
NPI:1700828431
Name:GALLUPE, DEAN RONALD (DO)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RONALD
Last Name:GALLUPE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 DUNLAWTON AVE # 200
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4901
Mailing Address - Country:US
Mailing Address - Phone:386-202-7770
Mailing Address - Fax:386-202-7771
Practice Address - Street 1:720 DUNLAWTON AVE # 200
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4901
Practice Address - Country:US
Practice Address - Phone:386-202-7770
Practice Address - Fax:386-202-7771
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004411207Q00000X
VA0102203688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
261083931OtherTAX ID
C10361OtherGROUP ORGANIZATION PTAN
DN2980OtherGROUP PTAN
P01309377OtherPTAN
FL115302000Medicaid
VA1700828431Medicaid
FL82466Medicare ID - Type Unspecified
FLD60647Medicare UPIN