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Individual

JOHN J GLEYSTEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5505
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C70731
VIVA
AL
01
MEDICARE
00017488
AL
Enumeration date
06/19/2006
Last updated
01/17/2008
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