Healthcare Provider Details

I. General information

NPI: 1689661860
Provider Name (Legal Business Name): RICHARD GINSBURG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/09/2007
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 NumberDO140
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS004860L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: