Provider Demographics
NPI:1407885254
Name:GAYLE, BENJAMIN L SR (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:GAYLE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2725
Mailing Address - Country:US
Mailing Address - Phone:251-432-4188
Mailing Address - Fax:251-432-4199
Practice Address - Street 1:1159 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2725
Practice Address - Country:US
Practice Address - Phone:251-432-4188
Practice Address - Fax:251-432-4199
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24746208M00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939331Medicaid
AL009935929Medicaid
AL515-34310OtherBCBS
AL515-34309OtherBCBS
AL009939329Medicaid
AL009935419Medicaid
AL515-40044OtherBCBS
AL009935931Medicaid
AL1407885254OtherTRICARE SOUTH
AL515-32773OtherBCBS
AL009936126Medicaid
AL510-04406OtherBCBS
AL515-34311OtherBCBS
AL515-97420OtherBCBS
ALP00299917Medicare PIN
AL515-34309OtherBCBS
AL515-40044OtherBCBS
AL051558038Medicare PIN
ALP00418973Medicare PIN