Organization
FAMILY MEDICINE OF RUSSELLVILLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN ALBERT GREGORIO MD (MD/PRESIDENT)
(256) 332-8969
Entity
Organization
Contact information
Practice address
605 GANDY ST NE, RUSSELLVILLE, AL 35653-1911
(256) 332-8969
(256) 332-8353
Mailing address
PO BOX 99, RUSSELLVILLE, AL 35653-0099
(256) 332-8969
(256) 332-8353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529933001
—
AL
Enumeration date
12/06/2007
Last updated
03/11/2008
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