Healthcare Provider Details

I. General information

NPI: 1053790873
Provider Name (Legal Business Name): RYNE SAMPLE SCHLITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 10/18/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DRIVE SUITE 110
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

3104 BLUE LAKE DRIVE SUITE 110
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax:
Mailing address:
  • Phone: 205-977-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.35446
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: