Provider Demographics
NPI:1811963861
Name:GALLOWAY, WILLIAM W (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0843
Mailing Address - Country:US
Mailing Address - Phone:479-968-6969
Mailing Address - Fax:479-968-4290
Practice Address - Street 1:1602 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2720
Practice Address - Country:US
Practice Address - Phone:479-968-6969
Practice Address - Fax:479-968-4290
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4599207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAG5312006OtherDEA
ARAG5312006OtherDEA
AR51806Medicare ID - Type Unspecified