Healthcare Provider Details

I. General information

NPI: 1942408729
Provider Name (Legal Business Name): EASTERN SHORE ORTHOPAEDIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PLANTATION BLVD
FAIRHOPE AL
36532-2952
US

IV. Provider business mailing address

PO BOX 1212
FAIRHOPE AL
36533-1212
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-4033
  • Fax: 251-928-4032
Mailing address:
  • Phone: 251-928-4033
  • Fax: 251-928-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11349
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH3108
License Number StateAL

VIII. Authorized Official

Name: JOHN A RODRIGUEZ-FEO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-928-4033