Provider Demographics
NPI:1548282593
Name:MARLA J. GLEASON, MD
Entity type:Organization
Organization Name:MARLA J. GLEASON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-937-7016
Mailing Address - Street 1:2001 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4163
Mailing Address - Country:US
Mailing Address - Phone:251-937-7016
Mailing Address - Fax:251-937-7612
Practice Address - Street 1:2001 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4163
Practice Address - Country:US
Practice Address - Phone:251-937-7016
Practice Address - Fax:251-937-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014571Medicaid
AL000014571Medicaid