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General NPI Number Information
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NPI Number | 1679583157
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Entity Type | Individual
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Provider Name | GALEN V POOLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 346 CROSSGATES BLVD SUITE 101
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City | BRANDON
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State | MS
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Zip | 39042-2608
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Country | US
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Telephone | 601-825-6505
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Fax | 601-825-6569
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Provider Business Mailing Address
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Address Line | 346 CROSSGATES BLVD SUITE 101
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City | BRANDON
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State | MS
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Zip | 39042-2608
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Country | US
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Telephone | 601-825-6505
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Fax | 601-825-6569
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12067
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License Number State | MS
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