Provider Demographics
NPI:1497802177
Name:GULF SHORES MEDICAL CENTER
Entity Type:Organization
Organization Name:GULF SHORES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-968-7379
Mailing Address - Street 1:PO BOX 1859
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-1859
Mailing Address - Country:US
Mailing Address - Phone:251-968-7379
Mailing Address - Fax:251-968-5960
Practice Address - Street 1:200 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-968-7379
Practice Address - Fax:251-968-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72146Medicare UPIN
ALI722Medicare PIN