Individual
DR. JOHN GAYLE VAN DERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7101 US HIGHWAY 90, SUITE 202, DAPHNE, AL 36526-9512
(251) 625-8211
(251) 625-8219
Mailing address
7101 US HIGHWAY 90, SUITE 202, DAPHNE, AL 36526-9512
(251) 625-8211
(251) 625-8219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11539
AL
207Q00000X
Family Medicine Physician
14230
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051558401
—
AL
01
—
510-04616
BLUE CROSS OF AL
AL
Enumeration date
08/16/2006
Last updated
12/20/2014
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