Provider Demographics
NPI:1366412405
Name:GALLEN, KEVIN J (PA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:GALLEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1350 TAMIAMI TRL N
Mailing Address - Street 2:#202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5203
Mailing Address - Country:US
Mailing Address - Phone:239-262-0020
Mailing Address - Fax:239-262-5980
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:#202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5203
Practice Address - Country:US
Practice Address - Phone:239-262-0020
Practice Address - Fax:239-262-5980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101773363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA46858Medicare UPIN