Provider Demographics
NPI:1225036312
Name:GANDY, ROY E (MD)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:E
Last Name:GANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:E
Other - Last Name:GANDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MASTIN 101
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-445-8282
Practice Address - Fax:251-445-8281
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-07-01
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
AL6662208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277823800Medicaid
AL51539457OtherBCBS 1720 CENTER ST
AL000008042Medicaid
AL5108042OtherBCBS
AL51539539OtherBCBS 575 STANTON
AL009941402Medicaid
AL009941403Medicaid
MS00501046Medicaid
AL51539539OtherBCBS 575 STANTON
AL009941403Medicaid
AL000008042Medicaid