Healthcare Provider Details

I. General information

NPI: 1104868058
Provider Name (Legal Business Name): GREGORY R GALAKATOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 5015-B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

POST OFFICE BOX 50308
SAINT LOUIS MO
63105
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-5850
  • Fax: 314-395-2464
Mailing address:
  • Phone: 314-567-5850
  • Fax: 314-395-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number110323
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: