Organization
MEDPEDS OF DOTHAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN BOUTWELL (ADMINISTRATION)
(334) 671-2895
Entity
Organization
Contact information
Practice address
318 WESTGATE PKWY STE 2, DOTHAN, AL 36303-2963
(334) 671-2895
(334) 712-9430
Mailing address
318 WESTGATE PARKWAY STE 2, DOTHAN, AL 36303
(334) 671-2895
(334) 712-9430
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00024928
AL
2080A0000X
Pediatric Adolescent Medicine Physician
00024928
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009946055
—
AL
Enumeration date
06/12/2007
Last updated
07/16/2007
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