Provider Demographics
NPI:1811251119
Name:GULF COAST BEHAVIORAL MEDICINE P. C.
Entity type:Organization
Organization Name:GULF COAST BEHAVIORAL MEDICINE P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-965-2145
Mailing Address - Street 1:16478 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-8598
Mailing Address - Country:US
Mailing Address - Phone:251-965-2145
Mailing Address - Fax:251-965-2149
Practice Address - Street 1:16478 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-8598
Practice Address - Country:US
Practice Address - Phone:251-965-2145
Practice Address - Fax:251-965-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL205412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL122525Medicaid
AL122525Medicaid