Basic Information
| Provider Information | |||||||||
| NPI: | 1760460133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALE | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 246 | ||||||||
| Address2: | |||||||||
| City: | SNEEDVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378690246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237331191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5052 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012612587 | ||||||||
| FaxNumber: | 6012613201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 27593 | IA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0065466 | 05 | IA | MEDICAID |