Provider Demographics
NPI:1265705933
Name:GALLER, BLAKE (DO)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:GALLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CUSTER RD.
Mailing Address - Street 2:STE 270 #1592
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:616-326-9762
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7254
Practice Address - Country:US
Practice Address - Phone:907-357-9590
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1090207N00000X
AK115179207N00000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program