Healthcare Provider Details

I. General information

NPI: 1992374334
Provider Name (Legal Business Name): RYAN PEACH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3423
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-7100
  • Fax: 205-297-9411
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-297-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4305
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: