Healthcare Provider Details

I. General information

NPI: 1114180932
Provider Name (Legal Business Name): ROSS J GALLUCCI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 E ORCHARD RD SUITE 100
GREENWOOD VILLAGE CO
80111-2583
US

IV. Provider business mailing address

7800 EAST ORCHARD ROAD 100
GREENWOOD VILLAGE CO
80111-2584
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-1300
  • Fax: 303-783-1200
Mailing address:
  • Phone: 303-697-7463
  • Fax: 303-783-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: