Provider Demographics
NPI:1174639926
Name:GALLOWAY, JOSEPH WARREN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WARREN
Last Name:GALLOWAY
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 1:1700 SPRINGHILL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604
Mailing Address - Country:US
Mailing Address - Phone:251-438-4440
Mailing Address - Fax:251-438-4599
Practice Address - Street 1:1700 SPRINGHILL AVE STE 400
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604
Practice Address - Country:US
Practice Address - Phone:251-438-4440
Practice Address - Fax:251-438-4599
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12158208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030543Medicaid
ALE40372Medicare UPIN