Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 26627 | KY |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 58519 | OH |
NPI | 1144225368 |
---|---|
Provider Name | Marc T Galloway |
First Address | Mason, OH 45040-9302 |
Second Address | Mason, OH 45040-7828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2185013 | (05) | OH |
64040116 | (05) | KY |
E38614 | (02) |