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NPI Code Detail

MEDICARE: DR. STANLEY A GALL JR. MD

MEDICARE: DR. STANLEY A GALL JR. 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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician38654TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4621112685OTHERTNUNITED HEALTHCARE

General Provider Information

NPI Number : 1982633467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STANLEY A GALL JR. MD
Provider Business Mailing Address
First Line : 105W STONE DR 6A
Second Line :
City : KINGSPORT
State : TN
Zip : 37660-3365
Country : US
Telephone Number : 423-408-7288
Fax Number : 423-408-7405
Provider Business Practice Location Address
First Line : 2050 MEADOWVIEW PKWY
Second Line :
City : KINGSPORT
State : TN
Zip : 37660-7475
Country : US
Telephone Number : 423-230-5000
Fax Number : 423-230-5035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/14/2015

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