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General NPI Number Information
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NPI Number | 1255420758
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Entity Type | Individual
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Provider Name | JOHN ALBERT INDOVINA JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15225 HIGHWAY 43 STE B-1
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1999
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Country | US
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Telephone | 256-332-8658
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Fax |
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Provider Business Mailing Address
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Address Line | 15225 HIGHWAY 43 STE B-1
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1999
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Country | US
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Telephone | 256-332-8658
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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 | MD021449
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD28281
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License Number State | AL
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