Healthcare Provider Details

I. General information

NPI: 1124288352
Provider Name (Legal Business Name): GREGORY R GALAKATOS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 03/17/2009
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:
  • Fax:

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: DR. GREGORY R GALAKATOS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 314-567-5850