MEDICARE: ASAHEL L GRIDLEY MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	ME168813	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578723599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASAHEL L GRIDLEY MD

Provider Business Mailing Address
First Line	:	4012 N 9TH AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2824
Country	:	US
Telephone Number	:	850-444-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 BAPTIST WAY STE 2C
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2274
Country	:	US
Telephone Number	:	850-444-4777
Fax Number	:

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

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	06/29/2026

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Directions to “ ASAHEL L GRIDLEY MD” Practice Location

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