Individual
JACOB GALLOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6335 S EAST ST, INDIANAPOLIS, IN 46227-7112
(317) 783-7474
Mailing address
5216 N 300 E, LA PORTE, IN 46350-8949
(219) 877-4805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001745A
IN
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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