Healthcare Provider Details

I. General information

NPI: 1356452403
Provider Name (Legal Business Name): MONTGOMERY KIDNEY SPECIALISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

IV. Provider business mailing address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

V. Phone/Fax

Practice location:
  • Phone: 334-269-0212
  • Fax: 334-269-2144
Mailing address:
  • Phone: 334-269-0212
  • Fax: 334-269-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL A. LOPEZ
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 334-269-0212