Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036119867 | IL |
Y | 207VG0400X | Gynecologist | R8567 | TX |
NPI | 1033319181 |
---|---|
Provider Name | Dr. Suzanne Marie Galloway |
First Address | El Paso, TX 79905-2707 |
Second Address | Wheaton, IL 60187-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206147 | MEDICARE PTAN GROUP (01) | IL |
F400274105 | MEDICARE PTAN INDIVIDUAL (01) | IL |