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General NPI Number Information
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NPI Number | 1356603401
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Entity Type | Organization
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Legal Business Name | GALLOWS INTERNAL MEDICINE, INC.
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 8408 ARLINGTON BLVD
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City | FAIRFAX
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State | VA
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Zip | 22031-4608
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Country | US
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Telephone | 703-462-8711
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Fax | 703-462-8719
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Provider Business Mailing Address
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Address Line | 8408 ARLINGTON BLVD
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City | FAIRFAX
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State | VA
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Zip | 22031-4608
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Country | US
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Telephone | 703-462-8711
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Fax | 703-462-8719
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN K MIN
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Credential | M.D.
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Telephone | 70346218711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101050013
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License Number State | VA
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