MEDICARE: DR. JOHN ALBERT INDOVINA JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD021449	LA
2	208600000X	Surgery Physician	MD28281	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255420758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALBERT INDOVINA JR. M.D.

Provider Business Mailing Address
First Line	:	15225 HIGHWAY 43 STE B-1
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1999
Country	:	US
Telephone Number	:	256-332-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	15225 HIGHWAY 43 STE B-1
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1999
Country	:	US
Telephone Number	:	256-332-8658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. JOHN ALBERT INDOVINA JR. M.D.” Practice Location

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