Healthcare Provider Details

I. General information

NPI: 1609962133
Provider Name (Legal Business Name): MONTGOMERY GASTROENTEROLOGY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4146 CARMICHAEL RD STE B
MONTGOMERY AL
36106-3634
US

IV. Provider business mailing address

4146 CARMICHAEL RD STE B
MONTGOMERY AL
36106-3634
US

V. Phone/Fax

Practice location:
  • Phone: 334-262-3737
  • Fax: 334-262-8955
Mailing address:
  • Phone: 334-262-3737
  • Fax: 334-262-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDO410
License Number StateAL

VIII. Authorized Official

Name: RICHARD GINSBURG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 334-262-3737