Provider Demographics
NPI:1679583157
Name:POOLE, GALEN V (MD)
Entity type:Individual
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First Name:GALEN
Middle Name:V
Last Name:POOLE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:346 CROSSGATES BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2608
Mailing Address - Country:US
Mailing Address - Phone:601-825-6505
Mailing Address - Fax:601-825-6569
Practice Address - Street 1:346 CROSSGATES BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2608
Practice Address - Country:US
Practice Address - Phone:601-825-6505
Practice Address - Fax:601-825-6569
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-04-21
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Provider Licenses
StateLicense IDTaxonomies
MS12067208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD91464Medicare UPIN