Healthcare Provider Details

I. General information

NPI: 1689619108
Provider Name (Legal Business Name): CHRISTOPHER M GALLOWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N WICKHAM RD SUITE 101
MELBOURNE FL
32940-2028
US

IV. Provider business mailing address

1073 CHATHAM BREAK ST
ORLANDO FL
32828-6860
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-2169
  • Fax: 321-253-1720
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: