Provider Demographics
NPI:1902856628
Name:GILSTRAP, JODY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:EDWARD
Last Name:GILSTRAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BROCKS GAP PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4028
Mailing Address - Country:US
Mailing Address - Phone:205-421-1032
Mailing Address - Fax:
Practice Address - Street 1:1001 BROCKS GAP PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4028
Practice Address - Country:US
Practice Address - Phone:205-421-1032
Practice Address - Fax:205-421-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158639801Medicaid
AL009910758Medicaid
TXG71281Medicare UPIN
TX158639801Medicaid
TX158639801Medicaid