Organization
RUSSELLVILLE DERMATOLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM W GALLOWAY M.D. (PRESIDENT / OWNER)
(479) 968-6969
Entity
Organization
Contact information
Practice address
1602 W MAIN ST, RUSSELLVILLE, AR 72801-2720
(479) 968-6969
(479) 968-4290
Mailing address
PO BOX 843, RUSSELLVILLE, AR 72811-0843
(479) 968-6969
(479) 968-4290
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
MC0841
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110005002
—
AR
Enumeration date
02/28/2006
Last updated
03/07/2023
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