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:
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Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336159607 NPPES
Mississippi MEDICAID 00123829
Mississippi Other 1559339
Mississippi MEDICAID 1768162

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