MEDICARE: DR. WILLIAM LANGLEY PRIDGEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	00022573	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51098967	OTHER	AL	BLUE CROSS AND BLUE SHIELD OF ALABAMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629017736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LANGLEY PRIDGEN M.D.

Provider Business Mailing Address
First Line	:	1837 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-366-0696
Fax Number	:	205-366-1451

Provider Business Practice Location Address
First Line	:	1837 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-366-0696
Fax Number	:	205-366-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	08/18/2016

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