Provider Demographics
NPI:1528035680
Name:GIALDE, JOSEPH S (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:GIALDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1192
Mailing Address - Country:US
Mailing Address - Phone:660-885-8171
Mailing Address - Fax:660-890-8495
Practice Address - Street 1:1701 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-3201
Practice Address - Country:US
Practice Address - Phone:660-885-8171
Practice Address - Fax:660-890-8495
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7873023Medicare ID - Type Unspecified
MOE48831Medicare UPIN