Organization
LAKESHORE PEDIATRICS OF RUSSELLVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AGUSTIN RIVAS M.D. (OWNER)
(256) 386-4151
Entity
Organization
Contact information
Practice address
603 GANDY ST NE, RUSSELLVILLE, AL 35653-1911
(256) 331-5055
(256) 383-7293
Mailing address
1120 S JACKSON HWY, SUITE 304, SHEFFIELD, AL 35660-5777
(256) 386-4151
(256) 383-7293
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2006323
AL
Other
Enumeration date
11/29/2007
Last updated
11/29/2007
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