Provider Demographics
NPI:1538118062
Name:GALLOWAY, JOEL R (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
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 1:910 W 5TH AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2966
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-155-6580
Practice Address - Street 1:910 W 5TH AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2966
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00029917207RC0000X, 207RI0011X
WAMD00029917207RI0011X
IDM-6492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003706100Medicaid
WA8155475Medicaid
WAG000352412Medicare PIN
WA8155475Medicaid
WA000352412Medicare ID - Type Unspecified
ID11408911Medicare PIN
ID003706100Medicaid