| Name: | Baldwin Pediatrics, Gerard P. Galle, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 Feb 1997 (28 years ago) |
| Entity Number: | 000-185-862 |
| Register Number: | 000185862 |
| Historical Names: |
Bay Pediatrics Gerard P. Galle, M.D., P.C.
|
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | DAPHNE, AL |
| Registered Office Street Address: | 503 OAK RIDGE COURT EDAPHNE, AL 36526 |
| Registered Office Street Address ZIP Code: | 36526 |
| Authorized Capital: | $10,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598820797 | 2006-12-27 | 2012-11-20 | PO BOX 336, MONTROSE, AL, 365590336, US | 1290 MAIN ST, C, DAPHNE, AL, 365268623, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-626-1861 |
| Fax | 2516210540 |
Authorized person
| Name | DR. GERARD PAUL GALLE SR. |
| Role | PRESIDENT |
| Phone | 2516261861 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 9862 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA PROVIDER NUMBER |
| Number | 5411047 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51032304 |
| State | AL |
| Name | Role |
|---|---|
| GALLE, GERARD P | Agent |
| Name | Role | Address |
|---|---|---|
| MILLING, BROOKS P | Incorporator | 104 ST FRANCIS ST SUITE 300MOBILE, AL 36602 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1997-11-14 | Name Change | Bay Pediatrics Gerard P. Galle, M.D., P.C. | Baldwin Pediatrics, Gerard P. Galle, M.D., P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
