Healthcare Provider Details

I. General information

NPI: 1689966145
Provider Name (Legal Business Name): MAXX GALLEGOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAX GALLEGOS M.D.

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE STE 200
BOULDER CO
80303-1225
US

IV. Provider business mailing address

5495 ARAPAHOE AVE STE 200
BOULDER CO
80303-1225
US

V. Phone/Fax

Practice location:
  • Phone: 512-446-9486
  • Fax:
Mailing address:
  • Phone: 303-381-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberU6956
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC191208
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD2017-0027
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR0072419
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: