Provider Demographics
NPI:1194811497
Name:NORTH ALABAMA OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:NORTH ALABAMA OBSTETRICS AND GYNECOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-461-4104
Mailing Address - Street 1:3809 SULLIVAN ST
Mailing Address - Street 2:SUITE 6-A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2372
Mailing Address - Country:US
Mailing Address - Phone:256-461-4104
Mailing Address - Fax:256-461-4840
Practice Address - Street 1:3809 SULLIVAN ST
Practice Address - Street 2:SUITE 6-A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2372
Practice Address - Country:US
Practice Address - Phone:256-461-4104
Practice Address - Fax:256-461-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51097396OtherBLUE CROSS&BLUE SHIELD
ALA64536Medicare UPIN