Provider Demographics
NPI:1144697251
Name:GALLARDO, EDUARDO (NP)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:9511 WEIDNER LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4874
Mailing Address - Country:US
Mailing Address - Phone:956-640-5204
Mailing Address - Fax:
Practice Address - Street 1:1102 W WAUGH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8769
Practice Address - Country:US
Practice Address - Phone:706-277-2321
Practice Address - Fax:706-428-2812
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily