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General NPI Number Information
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NPI Number | 1033108436
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Entity Type | Individual
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Provider Name | DAVID L RADER MD P C
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 09/03/2023
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Provider Practice Location Address
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Address Line | 3746 E FAIRWAY DR
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-4214
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Country | US
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Telephone | 205-447-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 3746 E FAIRWAY DR
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-4214
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Country | US
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Telephone | 54-474-7112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 11987
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 11987
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License Number State | AL
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