Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2802 | TX |
NPI | 1396859070 |
---|---|
Provider Name | Dr. Robert Lee Galloway III |
First Address | Houston, TX 77070-6211 |
Second Address | Houston, TX 77070-6211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T13377 | (02) | TX |