MEDICARE: DR. EDGAR BLACKMAN GALLOWAY III 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	207Y00000X	Otolaryngology Physician	38400	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841299567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR BLACKMAN GALLOWAY III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9190
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80932-0190
Country	:	US
Telephone Number	:	719-867-7800
Fax Number	:	719-867-7899

Provider Business Practice Location Address
First Line	:	3030 N CIRCLE DR
Second Line	:	STE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1177
Country	:	US
Telephone Number	:	719-867-7800
Fax Number	:	719-867-7899

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/16/2016

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