Healthcare Provider Details

I. General information

NPI: 1184773749
Provider Name (Legal Business Name): HUNTSVILLE REPRODUCTIVE MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CHATEAU DR SW SUITE 301
HUNTSVILLE AL
35801-7416
US

IV. Provider business mailing address

185 CHATEAU DR SW SUITE 301
HUNTSVILLE AL
35801-7416
US

V. Phone/Fax

Practice location:
  • Phone: 256-213-2229
  • Fax: 256-213-9978
Mailing address:
  • Phone: 256-213-2229
  • Fax: 256-213-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25020
License Number StateAL

VIII. Authorized Official

Name: MR. DOUGLAS HEIDEL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 256-213-2229