Healthcare Provider Details

I. General information

NPI: 1093825127
Provider Name (Legal Business Name): ROOSEVELT MCCORVEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 BELL RD
MONTGOMERY AL
36117-4336
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-8980
  • Fax: 334-747-8970
Mailing address:
  • Phone: 334-273-4159
  • Fax: 334-273-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.7451
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: