Healthcare Provider Details

I. General information

NPI: 1063411171
Provider Name (Legal Business Name): RICHARD JASON VALENTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SHELL RD
SARALAND AL
36571-2202
US

IV. Provider business mailing address

95 SHELL RD
SARALAND AL
36571-2202
US

V. Phone/Fax

Practice location:
  • Phone: 251-675-4733
  • Fax: 251-679-9874
Mailing address:
  • Phone: 251-675-4733
  • Fax: 251-679-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00026086
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: