Healthcare Provider Details

I. General information

NPI: 1225036312
Provider Name (Legal Business Name): ROY E GANDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROY E GANDY MD

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

2451 FILLINGIM ST MASTIN 101
MOBILE AL
36617-2238
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-8282
  • Fax: 251-445-8281
Mailing address:
  • Phone: 251-470-5842
  • Fax: 251-470-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6662
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: