Provider Demographics
NPI:1831684463
Name:GALLO, TYLER (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GALLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982005 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2055
Mailing Address - Country:US
Mailing Address - Phone:402-595-3939
Mailing Address - Fax:402-595-3898
Practice Address - Street 1:982005 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2055
Practice Address - Country:US
Practice Address - Phone:402-595-3939
Practice Address - Fax:402-595-3898
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine