1225036312 NPI number — MR. ROY E GANDY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225036312 NPI number — MR. ROY E GANDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDY
Provider First Name:
ROY
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GANDY
Provider Other First Name:
ROY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225036312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-470-5842
Provider Business Mailing Address Fax Number:
251-470-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2451 FILLINGIM ST
Provider Second Line Business Practice Location Address:
MASTIN 101
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36617-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-445-8282
Provider Business Practice Location Address Fax Number:
251-445-8281
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  6662 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 277823800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51539457 . This is a "BCBS 1720 CENTER ST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000008042 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5108042 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51539539 . This is a "BCBS 575 STANTON" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009941402 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009941403 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00501046 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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