Healthcare Provider Details

I. General information

NPI: 1265456180
Provider Name (Legal Business Name): JOHN J GALLUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N DIVISION ST SUITE 100
AUBURN WA
98001-4918
US

IV. Provider business mailing address

3920 CAPITAL MALL DR SW SUITE 100
OLYMPIA WA
98501-8701
US

V. Phone/Fax

Practice location:
  • Phone: 253-877-9333
  • Fax: 253-887-0169
Mailing address:
  • Phone: 360-753-4700
  • Fax: 360-753-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD00025245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: