Basic Information
| Provider Information | |||||||||
| NPI: | 1477729036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | SANFORD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 CYPRESS MANOR LN | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306063911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063545770 | ||||||||
| FaxNumber: | 7063545769 | ||||||||
| Practice Location | |||||||||
| Address1: | 7855 DIVISION DR | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440604877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063545770 | ||||||||
| FaxNumber: | 7063545769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | 35048103 | OH | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.