Provider Demographics
NPI:1093702458
Name:GLEASON, MARLA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:JEAN
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4163
Mailing Address - Country:US
Mailing Address - Phone:251-937-7016
Mailing Address - Fax:251-937-7612
Practice Address - Street 1:2001 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4163
Practice Address - Country:US
Practice Address - Phone:251-937-7016
Practice Address - Fax:251-937-7612
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51014571OtherBLUE CROSS BLUE SHIELD AL
AL000014571Medicaid
AL000014571Medicare ID - Type Unspecified
ALC74767Medicare UPIN