Provider Demographics
NPI:1154555167
Name:GUO, RONGJUN (MD)
Entity type:Individual
Prefix:
First Name:RONGJUN
Middle Name:
Last Name:GUO
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 1:1802 6TH AVE S
Mailing Address - Street 2:3544 NORTH PAVILION, DIVISION OF ANATOMIC PATHOLOGY
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1932
Mailing Address - Country:US
Mailing Address - Phone:610-306-3088
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:NP 3544, THE UNIVERSITY OF ALABAMA AT BIRMINGHAM
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-7331
Practice Address - Country:US
Practice Address - Phone:610-306-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 33461207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program