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General NPI Number Information
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NPI Number | 1811121411
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Entity Type | Organization
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Legal Business Name | GUMTREE MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 1306 BELK BLVD STE A
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City | OXFORD
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State | MS
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Zip | 38655-5302
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Country | US
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Telephone | 662-236-6636
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Fax | 662-236-6602
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Provider Business Mailing Address
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Address Line | 1306 BELK BLVD STE A
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City | OXFORD
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State | MS
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Zip | 38655-5302
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Country | US
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Telephone | 662-236-6636
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Fax | 662-236-6602
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY JOHN HALE
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Credential | M.D.
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Telephone | 662-236-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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