Healthcare Provider Details

I. General information

NPI: 1295828770
Provider Name (Legal Business Name): THE CANCER CENTER OF SOUTHERN ALABAMA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR STE 306
MOBILE AL
36607-3515
US

IV. Provider business mailing address

PO BOX 91119
MOBILE AL
36691-1119
US

V. Phone/Fax

Practice location:
  • Phone: 251-544-5400
  • Fax: 251-433-3122
Mailing address:
  • Phone: 251-544-5400
  • Fax: 251-433-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2085R0001X
License Number StateAL

VIII. Authorized Official

Name: DR. JOHN R RUSSELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-544-5400