Provider Demographics
NPI:1962475194
Name:GARYFALLOU, GARYFALLOS T (MD)
Entity Type:Individual
Prefix:
First Name:GARYFALLOS
Middle Name:T
Last Name:GARYFALLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5788
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5788
Mailing Address - Country:US
Mailing Address - Phone:303-202-1280
Mailing Address - Fax:303-202-1281
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:ST. ANTHONY HOSPITAL, EMERGENCY DEPT.
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-4161
Practice Address - Fax:720-321-4165
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35106207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01351063Medicaid
WY122686000Medicaid
AZ143822Medicaid
KS200401010AMedicaid
COP00335104OtherRR MEDICARE
UTZ3286Medicaid
COP00335104OtherRR MEDICARE
WY122686000Medicaid