Provider Demographics
NPI:1316942634
Name:GALLAWA, TOBIN C (DPM)
Entity type:Individual
Prefix:
First Name:TOBIN
Middle Name:C
Last Name:GALLAWA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2322 BUTANO DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0687
Mailing Address - Country:US
Mailing Address - Phone:916-488-8750
Mailing Address - Fax:916-488-7767
Practice Address - Street 1:2322 BUTANO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0687
Practice Address - Country:US
Practice Address - Phone:916-488-8750
Practice Address - Fax:916-488-7767
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4375213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43750Medicare ID - Type Unspecified
CAU52316Medicare UPIN
CA4416770001Medicare NSC