Healthcare Provider Details

I. General information

NPI: 1528021474
Provider Name (Legal Business Name): RIZK M ABDEL MOUTAGALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 GANDY ST
RUSSELLVILLE AL
35653
US

IV. Provider business mailing address

PO BOX 580
RUSSELLVILLE AL
35653
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-1175
  • Fax: 256-332-1171
Mailing address:
  • Phone: 256-332-1175
  • Fax: 256-332-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22718
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22718
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: