Provider Demographics
NPI:1700995065
Name:GAPULTOS, FILOMENO C JR (MD)
Entity Type:Individual
Prefix:
First Name:FILOMENO
Middle Name:C
Last Name:GAPULTOS
Suffix:JR
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 1:1100 S JACKSON HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5769
Mailing Address - Country:US
Mailing Address - Phone:256-386-4488
Mailing Address - Fax:256-381-2749
Practice Address - Street 1:1100 S JACKSON HWY STE 200
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5769
Practice Address - Country:US
Practice Address - Phone:256-386-4488
Practice Address - Fax:256-381-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003795Medicaid
AL000003795Medicaid
AL000003795Medicare ID - Type Unspecified