Individual
KENNETH RAYNOR GALLUP JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 CHATHAM MEDICAL PARK, ELKIN, NC 28621-2445
(336) 527-7198
(336) 527-8379
Mailing address
3001 LYNDHURST AVE, WINSTON SALEM, NC 27103
(336) 765-0383
(336) 768-1737
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
18642
NC
207RP1001X
Pulmonary Disease Physician
18642
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34396
—
NC
Enumeration date
11/15/2005
Last updated
08/26/2016
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