Healthcare Provider Details

I. General information

NPI: 1861472540
Provider Name (Legal Business Name): JEFFORY JEROME PRYLINSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4421
US

IV. Provider business mailing address

2006 FRANKLIN ST SE STE 301
HUNTSVILLE AL
35801-4551
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1000
  • Fax:
Mailing address:
  • Phone: 256-539-9471
  • Fax: 256-539-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO-679
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: