Healthcare Provider Details

I. General information

NPI: 1598834426
Provider Name (Legal Business Name): GALE TIMOTHY TUPER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MACK BAYOU LOOP STE 102
SANTA ROSA BEACH FL
32459-7194
US

IV. Provider business mailing address

307 BOATNER RD STE 114 96TH MEDICAL GROUP
EGLIN AFB FL
32542-1302
US

V. Phone/Fax

Practice location:
  • Phone: 850-797-6191
  • Fax: 850-660-9682
Mailing address:
  • Phone: 850-883-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberFT8148997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: