Healthcare Provider Details

I. General information

NPI: 1790702777
Provider Name (Legal Business Name): WILLIAM R GALLIVAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W JUNIPERO ST
SANTA BARBARA CA
93105-4305
US

IV. Provider business mailing address

320 W JUNIPERO ST
SANTA BARBARA CA
93105-4305
US

V. Phone/Fax

Practice location:
  • Phone: 805-220-6020
  • Fax: 805-284-0085
Mailing address:
  • Phone: 805-220-6020
  • Fax: 805-284-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG73901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG73901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: