Provider Demographics
NPI:1790789600
Name:BEARDSLEY, GALE ROLLAND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:ROLLAND
Last Name:BEARDSLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1629 WILDER AVE APT 704
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4666
Mailing Address - Country:US
Mailing Address - Phone:808-721-7278
Mailing Address - Fax:808-207-3799
Practice Address - Street 1:1629 WILDER AVE APT 704
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-4666
Practice Address - Country:US
Practice Address - Phone:808-721-7278
Practice Address - Fax:808-207-3799
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2021-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD40832084P0800X
CAG1516972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04758501Medicaid
HI04758501Medicaid
HI043390Medicare UPIN