Provider Demographics
NPI:1881600591
Name:GALE, HOWARD M (DPM)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:GALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2591
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2591
Mailing Address - Country:US
Mailing Address - Phone:912-681-8000
Mailing Address - Fax:912-681-8500
Practice Address - Street 1:1088 B BERMUDA RUN ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1088
Practice Address - Country:US
Practice Address - Phone:912-681-8000
Practice Address - Fax:912-681-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000725213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000597781LMedicaid
GA11D2020891OtherCLIA NUMBER
GA000597781JMedicaid
GA00597781MMedicaid
GA000597781KMedicaid
GA000597781KMedicaid
GA00597781MMedicaid
GA48SCCFWMedicare PIN
GA202G703154Medicare PIN