Provider Demographics
NPI:1831326370
Name:GALLOWAY, BRENT WESLEY JR (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WESLEY
Last Name:GALLOWAY
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3913 STABLEGLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0129
Mailing Address - Country:US
Mailing Address - Phone:918-891-8231
Mailing Address - Fax:
Practice Address - Street 1:3913 STABLEGLEN DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0129
Practice Address - Country:US
Practice Address - Phone:918-891-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054156207Q00000X
OK29413207Q00000X
NMMD2015-0006207Q00000X
HIMD-18050207Q00000X
ORMD170988207Q00000X
FLME122634207Q00000X
IDM-12808207Q00000X
WY10089A207Q00000X
WAMD60525585207Q00000X
NY278194-1207Q00000X
NV15847207Q00000X
CAC136415207Q00000X
AZ50165207Q00000X
MT37111207Q00000X
TXN4420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine