Provider Demographics
NPI:1417997842
Name:ROY GANDY MD PC
Entity Type:Organization
Organization Name:ROY GANDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-580-4600
Mailing Address - Street 1:2305 HAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4191
Mailing Address - Country:US
Mailing Address - Phone:251-580-4600
Mailing Address - Fax:251-580-4160
Practice Address - Street 1:2305 HAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4191
Practice Address - Country:US
Practice Address - Phone:251-580-4600
Practice Address - Fax:251-580-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6662261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70716Medicare UPIN