Healthcare Provider Details

I. General information

NPI: 1568680163
Provider Name (Legal Business Name): GLENN TODD GALLASPY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 DAUPHIN STREET SUITE 2-A
MOBILE AL
36608
US

IV. Provider business mailing address

3715 DAUPHIN STREET SUITE 2-A
MOBILE AL
36608
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-5265
  • Fax: 251-344-5321
Mailing address:
  • Phone: 251-344-5265
  • Fax: 251-344-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number41680
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number41680
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: