Healthcare Provider Details

I. General information

NPI: 1578560959
Provider Name (Legal Business Name): RAYMOND NEIL BRIGNAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEDICAL CENTER PKWY
SELMA AL
36701-6746
US

IV. Provider business mailing address

901 MEDICAL CENTER PKWY
SELMA AL
36701-6746
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-2640
  • Fax: 334-875-2645
Mailing address:
  • Phone: 334-875-2640
  • Fax: 334-875-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number00008538
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: