Organization
BRENT WESLEY GALLOWAY JR MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT WESLEY GALLOWAY JR. MD (MD)
(918) 891-8231
Entity
Organization
Contact information
Practice address
3913 STABLEGLEN DR, ROCKWALL, TX 75032-0129
(918) 891-8231
Mailing address
3913 STABLEGLEN DR, ROCKWALL, TX 75032-0129
(918) 891-8231
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29413
OK MED LICENSE
OK
01
—
N4420
MEDICAL LICENSE
TX
Enumeration date
06/08/2012
Last updated
04/27/2021
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