Healthcare Provider Details

I. General information

NPI: 1043615180
Provider Name (Legal Business Name): WILLIAM R. GALLIVAN, JR., M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/08/2015
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 TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM R GALLIVAN JR.
Title or Position: PRESIDENT
Credential:
Phone: 805-220-6020