Provider Demographics
NPI:1336162338
Name:GALLMAN, BURNETT WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:BURNETT
Middle Name:WILLIAM
Last Name:GALLMAN
Suffix:JR
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 1:4100 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5800
Mailing Address - Country:US
Mailing Address - Phone:803-786-0980
Mailing Address - Fax:803-786-6452
Practice Address - Street 1:4100 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:803-786-0980
Practice Address - Fax:803-786-6452
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99244207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0099244Medicaid
SCB918170281Medicare PIN
SC0099244Medicaid