1407885254 NPI number — BENJAMIN L GAYLE SR. MD

Table of content: BENJAMIN L GAYLE SR. MD (NPI 1407885254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407885254 NPI number — BENJAMIN L GAYLE SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAYLE
Provider First Name:
BENJAMIN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407885254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1159 SPRING HILL AVE
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:
36604-2725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-432-4188
Provider Business Mailing Address Fax Number:
251-432-4199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1159 SPRING HILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-432-4188
Provider Business Practice Location Address Fax Number:
251-432-4199
Provider Enumeration Date:
07/02/2006

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: 208M00000X , with the licence number:  MD.24746 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD.24746 , 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: 009939331 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009935929 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-34310 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-34309 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009939329 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009935419 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-40044 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009935931 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407885254 . This is a "TRICARE SOUTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-32773 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936126 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-04406 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-34311 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-97420 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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