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General NPI Number Information
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NPI Number | 1477529436
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE DERMATOLOGY CLINIC PA
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1602 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2720
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Country | US
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Telephone | 479-968-6969
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Fax | 479-968-4290
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Provider Business Mailing Address
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Address Line | PO BOX 843
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-0843
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Country | US
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Telephone | 479-968-6969
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Fax | 479-968-4290
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. WILLIAM W GALLOWAY
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Credential | M.D.
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Telephone | 479-968-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | MC0841
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License Number State | AR
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