Healthcare Provider Details

I. General information

NPI: 1407938368
Provider Name (Legal Business Name): ALAN DALE GATLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15012 LEMOYNE BLVD
BILOXI MS
39532-5205
US

IV. Provider business mailing address

15012 LEMOYNE BLVD
BILOXI MS
39532-5205
US

V. Phone/Fax

Practice location:
  • Phone: 228-396-1285
  • Fax: 228-396-9562
Mailing address:
  • Phone: 228-396-1285
  • Fax: 228-396-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number17244
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17244
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: