Gallardo, Mark A
Gallardo, Mark A is an individual health care provider with primary practice located at 104 Asbury Cir , Hattiesburg MS 39402-1302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Gallardo, Mark A can be contacted via phone (601) 268-5252.Contact Information
Primary practice address
104 Asbury Cir
Hattiesburg MS 39402-1302
Phone: (601) 268-5252
Fax: (601) 268-5190
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 17102 | Mississippi |
Profile Details
| NPI number | 1336159607 |
|---|---|
| LBN Legal business name | Gallardo, Mark A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 9th, 2006 |
| Last updated | Jul 14th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336159607 | NPPES |
| Mississippi | MEDICAID | 00123829 | |
| Mississippi | Other | 1559339 | |
| Mississippi | MEDICAID | 1768162 |
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