Individual
GREGORY S BORUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
124 BLUFF SPRING DR, MADISON, AL 35758-7386
(256) 325-4075
Mailing address
PO BOX 6568, HUNTSVILLE, AL 35824-0568
(256) 325-4075
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DO-719
AL
207R00000X
Internal Medicine Physician
DO-719
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-1381-06
LICENSE
NM
01
—
CS00211972
CONTROLLED SUBSTANCE
NM
01
—
DO-719
LICENSE
AL
Enumeration date
01/05/2006
Last updated
03/07/2023
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