Provider Demographics
NPI:1376533992
Name:BALE, PHILLIP W (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:W
Last Name:BALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-780-2497
Mailing Address - Fax:270-783-3750
Practice Address - Street 1:1330 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3465
Practice Address - Country:US
Practice Address - Phone:270-629-5111
Practice Address - Fax:270-783-3760
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64200629Medicaid
KY64200629Medicaid
KY0525102Medicare PIN
KY0515203Medicare PIN
KY00388001Medicare PIN