Provider Demographics
NPI:1053410993
Name:MIDDLETON, GUY MALCOLM (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:MALCOLM
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-673-3633
Mailing Address - Fax:334-836-2893
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 402
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-673-3633
Practice Address - Fax:334-836-2893
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25364207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL74-10781OtherUNITED HEALTHCARE
FL16691OtherBLUE CROSS BLUE SHIELD
AL515-16936OtherBLUE CROSS BLUE SHIELD
FL16691OtherBLUE CROSS BLUE SHIELD