MEDICARE: JOSEPH S GIALDE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R5417	MO

General Provider Information

NPI Number	:	1528035680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH S GIALDE D.O.

Provider Business Mailing Address
First Line	:	1602 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	660-885-8171
Fax Number	:	660-890-8495

Provider Business Practice Location Address
First Line	:	1701 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-3201
Country	:	US
Telephone Number	:	660-885-8171
Fax Number	:	660-890-8495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	04/29/2009

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