Provider Demographics
NPI:1376646505
Name:OSWALT, GUY COLEMAN JR (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:COLEMAN
Last Name:OSWALT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:COLEMAN
Other - Last Name:OSWALT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:168 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3510
Mailing Address - Country:US
Mailing Address - Phone:251-433-1895
Mailing Address - Fax:251-433-1917
Practice Address - Street 1:168 MOBILE INFIRMARY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3510
Practice Address - Country:US
Practice Address - Phone:251-433-1895
Practice Address - Fax:251-433-1917
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL07460208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051002897OtherBCBS
AL000002897Medicaid
AL051002897OtherBCBS
AL000002897Medicare PIN
AL340006019Medicare PIN