Healthcare Provider Details

I. General information

NPI: 1548282593
Provider Name (Legal Business Name): MARLA J. GLEASON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL CENTER DR
BAY MINETTE AL
36507-4163
US

IV. Provider business mailing address

2001 MEDICAL CENTER DR
BAY MINETTE AL
36507-4163
US

V. Phone/Fax

Practice location:
  • Phone: 251-937-7016
  • Fax: 251-937-7612
Mailing address:
  • Phone: 251-937-7016
  • Fax: 251-937-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11955
License Number StateAL

VIII. Authorized Official

Name: DR. MARLA J GLEASON
Title or Position: OWENER
Credential: MD
Phone: 251-937-7016