Provider Demographics
NPI:1831151141
Name:GALLOWAY, JAMES RANDALL (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-4520
Mailing Address - Fax:231-487-7723
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:NORTHERN MICHIGAN HOSPITAL
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-4520
Practice Address - Fax:231-487-7723
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014037207P00000X, 207L00000X
NMA-1193-02207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH75063Medicare UPIN