1598820797 NPI number — BALDWIN PEDIATRICS, GERARD P GALLE, M. D.

Table of content: (NPI 1598820797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598820797 NPI number — BALDWIN PEDIATRICS, GERARD P GALLE, M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALDWIN PEDIATRICS, GERARD P GALLE, M. D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GERARD P GALLE, M. D.
Provider Other Organization Name Type Code:
5
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:
1598820797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36559-0336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-626-1861
Provider Business Mailing Address Fax Number:
251-621-0540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 MAIN ST
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-8623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-1861
Provider Business Practice Location Address Fax Number:
251-621-0540
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLE
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-626-1861

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  9862 , 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: 5411047 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51032304 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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