Healthcare Provider Details

I. General information

NPI: 1679649255
Provider Name (Legal Business Name): SAMUEL MICHAEL GALVAGNO JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

V. Phone/Fax

Practice location:
  • Phone: 480-549-6756
  • Fax:
Mailing address:
  • Phone: 480-549-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number011817
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number222158
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number225891
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberH67019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: