Healthcare Provider Details

I. General information

NPI: 1598820797
Provider Name (Legal Business Name): BALDWIN PEDIATRICS, GERARD P GALLE, M. D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 MAIN ST C
DAPHNE AL
36526-8623
US

IV. Provider business mailing address

PO BOX 336
MONTROSE AL
36559-0336
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-1861
  • Fax: 251-621-0540
Mailing address:
  • Phone: 251-626-1861
  • Fax: 251-621-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9862
License Number StateAL

VIII. Authorized Official

Name: DR. GERARD PAUL GALLE SR.
Title or Position: PRESIDENT
Credential: M. D.
Phone: 251-626-1861