Provider Demographics
NPI:1295722098
Name:SANTA MARIA, GALE V (MD)
Entity type:Individual
Prefix:
First Name:GALE
Middle Name:V
Last Name:SANTA MARIA
Suffix:
Gender:F
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 4330
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-4330
Mailing Address - Country:US
Mailing Address - Phone:970-926-6340
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:108 S FRONTAGE RD W
Practice Address - Street 2:SUITE 101
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5053
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97934755Medicaid
G86428Medicare UPIN
COG86428Medicare UPIN
CO301585Medicare PIN
CO97934755Medicaid
802512Medicare ID - Type Unspecified