Provider Demographics
NPI:1285732016
Name:GINEVAN, BRAD M (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:M
Last Name:GINEVAN
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:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2587
Mailing Address - Country:US
Mailing Address - Phone:256-383-4473
Mailing Address - Fax:256-381-5232
Practice Address - Street 1:342 COX BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4020
Practice Address - Country:US
Practice Address - Phone:256-383-4473
Practice Address - Fax:256-381-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326373861OtherGROUP NPI
AL051558900Medicare PIN
I62833Medicare UPIN
ALP00409897Medicare PIN
AL009942843Medicaid