Provider Demographics
NPI:1487793022
Name:GALLIGOS, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:GALLIGOS
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:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:2212 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2029
Practice Address - Country:US
Practice Address - Phone:417-831-8074
Practice Address - Fax:417-864-6585
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2005007767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207300401Medicaid
MO201134OtherMO BLUE SHIELD
AR83611OtherARK BLUE SHIELD
AR83611OtherARK BLUE SHIELD
MO934433268Medicare PIN