Individual
ROEL ANGEL GALLO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(480) 985-1093
(480) 985-0468
Mailing address
PO BOX 20490, MESA, AZ 85277-0490
(480) 985-1093
(480) 985-0468
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
21021
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497025
—
AZ
01
—
AX5901
HEALTHNET PROV NUMBER
AZ
01
—
AZ0876870
BCBS PROVIDER NUMBER
AZ
01
—
CB2931
RR MC GROUP PROV NUMBER
AZ
Enumeration date
02/15/2006
Last updated
01/24/2008
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