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NPI Code Detail

MEDICARE: RONALD E PHILLEY PA-C

MEDICARE: RONALD E PHILLEY PA-C
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
1363AS0400XSurgical Physician AssistantPA-386AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17803747OTHERAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
351534896OTHERALBCBS

General Provider Information

NPI Number : 1629079918
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD E PHILLEY PA-C
Provider Business Mailing Address
First Line : 513 BROOKWOOD BLVD STE 101
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35209-6878
Country : US
Telephone Number : 205-933-8981
Fax Number : 205-930-0746
Provider Business Practice Location Address
First Line : 513 BROOKWOOD BLVD STE 101
Second Line :
City : HOMEWOOD
State : AL
Zip : 35209-6878
Country : US
Telephone Number : 205-933-8981
Fax Number : 205-930-0746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 05/12/2026

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1447347489 — ROBERT B POCZATEK MD
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1780905380 — JOSHUA YORK MENENDEZ M.D.
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1619388659 — DR. PAUL RICHARD CLARK M.D.
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Directions to “ RONALD E PHILLEY PA-C” Practice Location

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