1881600591 NPI number — DR. HOWARD M GALE DPM

Table of content: DR. HOWARD M GALE DPM (NPI 1881600591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881600591 NPI number — DR. HOWARD M GALE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALE
Provider First Name:
HOWARD
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1881600591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2591
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30459-2591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-681-8000
Provider Business Mailing Address Fax Number:
912-681-8500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 B BERMUDA RUN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30458-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-681-8000
Provider Business Practice Location Address Fax Number:
912-681-8500
Provider Enumeration Date:
08/01/2006

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: 213E00000X , with the licence number:  POD000725 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000597781L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11D2020891 . This is a "CLIA NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000597781J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00597781M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000597781K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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