Healthcare Provider Details

I. General information

NPI: 1124191267
Provider Name (Legal Business Name): STEVEN WAYNE GALYON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 BOONE AVE
WINSTON SALEM NC
27103-4853
US

IV. Provider business mailing address

2391 BOONE AVE
WINSTON SALEM NC
27103-4853
US

V. Phone/Fax

Practice location:
  • Phone: 336-671-1107
  • Fax:
Mailing address:
  • Phone: 336-671-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2007-01072
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10663
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9862
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: