Individual
MARK A GALLARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 ASBURY CIR, HATTIESBURG, MS 39402-1302
(601) 268-5252
(601) 268-5190
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5252
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
17102
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123829
—
MS
01
—
1559339
AMERICAN ADMIN GROUP
MS
05
—
1768162
—
LA
Enumeration date
08/09/2006
Last updated
07/14/2020
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