Provider Demographics
NPI:1124191267
Name:GALYON, STEVEN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:GALYON
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 1:2391 BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4853
Mailing Address - Country:US
Mailing Address - Phone:336-671-1107
Mailing Address - Fax:
Practice Address - Street 1:2391 BOONE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4853
Practice Address - Country:US
Practice Address - Phone:336-671-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10663207Y00000X
ND9862207Y00000X
NC2007-01072207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13255Medicaid
P00159095OtherRAILROAD MEDICARE
ND24897OtherBLUE CROSS
MT000098575OtherBLUE CROSS
MT0084269Medicaid
MT000084279Medicare ID - Type Unspecified
P00159095OtherRAILROAD MEDICARE
H92833Medicare UPIN