Provider Demographics
NPI:1538253075
Name:JANNUN, DINA RIYAD (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:RIYAD
Last Name:JANNUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5763
Mailing Address - Country:US
Mailing Address - Phone:256-764-7721
Mailing Address - Fax:256-764-8589
Practice Address - Street 1:426 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5763
Practice Address - Country:US
Practice Address - Phone:256-764-7721
Practice Address - Fax:256-764-8589
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL155602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960725Medicaid
AL51521155OtherBLUE CROSS BLUE SHIELD
AL51521155OtherBLUE CROSS BLUE SHIELD
AL051521155Medicare PIN