Individual
JEFFREY DERRICK MANORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15225 HIGHWAY 43 STE D, RUSSELLVILLE, AL 35653-1969
(256) 332-1500
(256) 398-8888
Mailing address
PO BOX 660, RUSSELLVILLE, AL 35653-0616
(256) 332-1500
(256) 398-8888
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD23436
AL
2086S0129X
Vascular Surgery Physician
Primary
23436
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126779
—
AL
01
—
511-17526
BCBS OF ALABAMA
AL
Enumeration date
05/20/2006
Last updated
03/29/2022
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