Provider Demographics
NPI:1982633467
Name:GALL, STANLEY A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:GALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:105W STONE DR 6A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7288
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:2050 MEADOWVIEW PKWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7475
Practice Address - Country:US
Practice Address - Phone:423-230-5000
Practice Address - Fax:423-230-5035
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38654208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00155019Medicaid
TN3894110Medicaid
TN010113253Medicaid
TN621112685OtherUNITED HEALTHCARE
TNG31010Medicare UPIN
TN3894110Medicaid