Provider Demographics
NPI:1659348019
Name:CRESPO-GALES, JACQUELINE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CRESPO-GALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WESTOVER CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4900
Mailing Address - Country:US
Mailing Address - Phone:256-461-0209
Mailing Address - Fax:256-325-3147
Practice Address - Street 1:101 WESTOVER CIR
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-4900
Practice Address - Country:US
Practice Address - Phone:256-461-0209
Practice Address - Fax:256-325-3147
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics