Provider Demographics
NPI:1558418426
Name:EWING, GIDEON P (MD)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:P
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11491 US HWY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950
Mailing Address - Country:US
Mailing Address - Phone:256-894-6750
Mailing Address - Fax:256-894-6781
Practice Address - Street 1:2505 HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957
Practice Address - Country:US
Practice Address - Phone:256-840-3688
Practice Address - Fax:256-840-3101
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000042600207RH0003X
AL31588207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology