Individual
SAMUEL ALEXANDER GALLUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19800 VILLAGE OFFICE CT STE 104, BEND, OR 97702-1813
(541) 480-2570
Mailing address
21204 SE GOLDEN MARKET LN, BEND, OR 97702-3651
(518) 727-4404
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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