Provider Demographics
NPI:1346620549
Name:GALLAGHER, TRACEY (BS)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S ULSTER ST APT 19-201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-4303
Mailing Address - Country:US
Mailing Address - Phone:720-254-0875
Mailing Address - Fax:303-368-4349
Practice Address - Street 1:10800 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2687
Practice Address - Country:US
Practice Address - Phone:303-368-5252
Practice Address - Fax:303-368-4349
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB2668175T00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine