Healthcare Provider Details

I. General information

NPI: 1487727764
Provider Name (Legal Business Name): JOHN RANDALL RIEHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 14TH AVE SE STE 300
DECATUR AL
35601-3368
US

IV. Provider business mailing address

1107 14TH AVE SE STE 300
DECATUR AL
35601-3368
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-0362
  • Fax:
Mailing address:
  • Phone: 256-350-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number00020616
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number00020616
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: