Russellville Dermatology Clinic PA

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

MC0841 Issued in AR

Legal business name

RUSSELLVILLE DERMATOLOGY CLINIC PA

Practice address

1602 W Main St
Russellville, AR 72801-2720

Phone

(479) 968-6969

Fax

(479) 968-4290

NPI assigned

Feb 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William W Galloway, M.D.

Title

President / Owner

Phone

(479) 968-6969

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1477529436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728110843",
            "telephone_number": "479-968-6969",
            "fax_number": "479-968-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012720",
            "telephone_number": "479-968-6969",
            "fax_number": "479-968-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE DERMATOLOGY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GALLOWAY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "479-968-6969",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AR",
            "license": "MC0841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110005002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Russellville, AR
• Providers in Russellville, AR by specialty
• Procedural Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.