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General NPI Number Information
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NPI Number | 1962718650
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Entity Type | Organization
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Legal Business Name | NORTHWEST ALABAMA SURGICAL SPECIALISTS, PC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 42030 HIGHWAY 195 SUITE C
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City | HALEYVILLE
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State | AL
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Zip | 35565-7054
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Country | US
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Telephone | 205-486-3800
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Fax | 205-486-3802
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Provider Business Mailing Address
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Address Line | PO BOX 1046
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City | HALEYVILLE
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State | AL
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Zip | 35565-1046
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Country | US
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Telephone | 205-486-3800
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Fax | 205-486-3802
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFF RYAN
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Credential | MD
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Telephone | 205-486-3800
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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 | 22074
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License Number State | AL
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