MEDICARE: DR. WILLIAM W GALLOWAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	C4599	AR

General Provider Information

NPI Number	:	1811963861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM W GALLOWAY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 843
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-0843
Country	:	US
Telephone Number	:	479-968-6969
Fax Number	:	479-968-4290

Provider Business Practice Location Address
First Line	:	1602 W MAIN ST
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-2720
Country	:	US
Telephone Number	:	479-968-6969
Fax Number	:	479-968-4290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/07/2023

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