Provider Demographics
NPI:1831167287
Name:GLADISH, REGINALD DWAIN (MD)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:DWAIN
Last Name:GLADISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1216 SOMERVILLE ROAD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-340-0012
Mailing Address - Fax:256-340-1408
Practice Address - Street 1:1216 SOMERVILLE ROAD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-340-0012
Practice Address - Fax:256-340-1408
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL18219207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79983Medicare UPIN