MEDICARE: DR. GAIL L BUNDOW 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	207P00000X	Emergency Medicine Physician	ME84021	FL
2	207P00000X	Emergency Medicine Physician	27349	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7572482	OTHER	AL	AETNA

General Provider Information

NPI Number	:	1881696128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL L BUNDOW MD

Provider Business Mailing Address
First Line	:	8678 EDGEHILL DR SE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-3786
Country	:	US
Telephone Number	:	256-880-4177
Fax Number	:	256-880-4507

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6455
Country	:	US
Telephone Number	:	256-880-4177
Fax Number	:	256-880-4507

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. GAIL L BUNDOW MD” Practice Location

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