Provider Demographics
NPI:1063699965
Name:ST. JOHN, ALBERT BENNETTE (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:BENNETTE
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21075 RABREN RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-8115
Mailing Address - Country:US
Mailing Address - Phone:334-222-9646
Mailing Address - Fax:334-222-9646
Practice Address - Street 1:21075 RABREN RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36421-8115
Practice Address - Country:US
Practice Address - Phone:334-222-9646
Practice Address - Fax:334-222-9646
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11531207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-31289STOtherBLUE CROSS
AL000031289Medicaid
AL11531OtherSTATE LICENSE/CONTROLLED
AL11531OtherSTATE LICENSE/CONTROLLED
AL000031289Medicaid
ALC75031Medicare UPIN