Provider Demographics
NPI:1992764013
Name:GALLOWAY, MICHAEL LEE (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 4TH ST STE 2C60
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4362
Mailing Address - Country:US
Mailing Address - Phone:432-703-5050
Mailing Address - Fax:432-335-5240
Practice Address - Street 1:701 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4206
Practice Address - Country:US
Practice Address - Phone:432-703-5510
Practice Address - Fax:432-335-1009
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500040207V00000X
OH34006095207V00000X
TXS2038207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2071994Medicaid
F94355Medicare UPIN
OHGA4214471Medicare PIN
OH2071994Medicaid