MEDICARE: GILLES BASTILLE M.D.

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	207Q00000X	Family Medicine Physician	00009111	AL

General Provider Information

NPI Number	:	1790798346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLES BASTILLE M.D.

Provider Business Mailing Address
First Line	:	1040 GLENN BLVD SW
Second Line	:
City	:	FT PAYNE
State	:	AL
Zip	:	35967-8413
Country	:	US
Telephone Number	:	256-845-6900
Fax Number	:	256-845-6911

Provider Business Practice Location Address
First Line	:	1040 GLENN BLVD SW
Second Line	:
City	:	FT PAYNE
State	:	AL
Zip	:	35967-8413
Country	:	US
Telephone Number	:	256-845-6900
Fax Number	:	256-845-6911

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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Directions to “ GILLES BASTILLE M.D.” Practice Location

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