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General NPI Number Information
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NPI Number | 1942408729
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE ORTHOPAEDIC CENTER, P.C.
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 912 PLANTATION BLVD
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City | FAIRHOPE
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State | AL
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Zip | 36532-2952
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Country | US
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Telephone | 251-928-4033
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Fax | 251-928-4032
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Provider Business Mailing Address
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Address Line | PO BOX 1212
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City | FAIRHOPE
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State | AL
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Zip | 36533-1212
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Country | US
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Telephone | 251-928-4033
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Fax | 251-928-4032
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN A RODRIGUEZ-FEO
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Credential | M.D.
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Telephone | 251-928-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH3108
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 11349
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License Number State | AL
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