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General NPI Number Information
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NPI Number | 1245992155
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Entity Type | Organization
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Legal Business Name | ADVANTAGE SURGICAL AND WOUND CARE ALABAMA PC
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 65 CHARLTON PL
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City | DEATSVILLE
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State | AL
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Zip | 36022-2697
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Country | US
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Telephone | 877-878-3289
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Fax | 877-817-3227
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Provider Business Mailing Address
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Address Line | 222 N PACIFIC COAST HWY STE 2175
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5639
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Country | US
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Telephone | 877-878-3289
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Fax | 877-817-3227
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Authorized Official
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Title or Position | PRESIDENT
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Name | URI GEDALIA
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Credential | MD
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Telephone | 877-878-3289
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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 |
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License Number State |
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