Healthcare Provider Details

I. General information

NPI: 1972922466
Provider Name (Legal Business Name): JOHN KIMY DEMIAN GUIRGUIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S UNIVERSITY BLVD STE A
MOBILE AL
36608-3078
US

IV. Provider business mailing address

720 2ND AVE STE 201
BOWLING GREEN KY
42101-1778
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5004
  • Fax: 251-343-8383
Mailing address:
  • Phone: 270-843-5114
  • Fax: 270-745-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number57.024042
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number55563
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number48579
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: