Healthcare Provider Details

I. General information

NPI: 1427089028
Provider Name (Legal Business Name): ALGER RIXEY SOUTHALL III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOOLFOLK AVE.
LOUISA VA
23093
US

IV. Provider business mailing address

PO BOX 1367
LOUISA VA
23093-1367
US

V. Phone/Fax

Practice location:
  • Phone: 540-967-2202
  • Fax: 540-967-1676
Mailing address:
  • Phone: 540-967-2202
  • Fax: 540-967-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101033308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: