MEDICARE: WILLIAM R GALLIVAN JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G73901	CA
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	G73901	CA

General Provider Information

NPI Number	:	1790702777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R GALLIVAN JR. M.D.

Provider Business Mailing Address
First Line	:	320 W JUNIPERO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4305
Country	:	US
Telephone Number	:	805-220-6020
Fax Number	:	805-284-0085

Provider Business Practice Location Address
First Line	:	320 W JUNIPERO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4305
Country	:	US
Telephone Number	:	805-220-6020
Fax Number	:	805-284-0085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/27/2015

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