Healthcare Provider Details

I. General information

NPI: 1053303602
Provider Name (Legal Business Name): WILLIAM GARY CUMBIE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST STE 500
MONTGOMERY AL
36106-1103
US

IV. Provider business mailing address

1722 PINE ST STE 500
MONTGOMERY AL
36106-1103
US

V. Phone/Fax

Practice location:
  • Phone: 334-264-9500
  • Fax: 334-264-9519
Mailing address:
  • Phone: 334-264-9500
  • Fax: 334-264-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7019
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: