MEDICARE: DR. MARLA JEAN GLEASON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	11955	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51014571	OTHER	AL	BLUE CROSS BLUE SHIELD AL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093702458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLA JEAN GLEASON MD

Provider Business Mailing Address
First Line	:	2001 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-937-7016
Fax Number	:	251-937-7612

Provider Business Practice Location Address
First Line	:	2001 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-937-7016
Fax Number	:	251-937-7612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	10/04/2011

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