Organization
W H GALLIMORE DO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCTS MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
1500 AVENUE H, ELY, NV 89301-2615
(775) 289-3001
Mailing address
3196 WILLOW CREEK RD, STE A103 BOX 245, PRESCOTT, AZ 86301-6689
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
DO
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005138
AZ LICENSE
AZ
01
—
DO1709
NV LICENSE
NV
Enumeration date
08/14/2012
Last updated
08/14/2012
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