Individual
GLENN DAVID BEDSOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 PINE ST, MONTGOMERY, AL 36106-0165
(334) 293-8138
(334) 293-8134
Mailing address
PO BOX 242848, MONTGOMERY, AL 36124-2848
(334) 270-9914
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
7601
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000018188
—
AL
01
—
51018188
BC/BS
AL
01
—
630979663
CHAMPUS/TRICARE
AL
Enumeration date
01/20/2006
Last updated
05/06/2015
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