Organization
CULLMAN SURGICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD RAY MARECLE M.D. (PRESIDENT)
(256) 739-6050
Entity
Organization
Contact information
Practice address
212 4TH AVE SE, SUITE 100, CULLMAN, AL 35055-3673
(256) 739-6050
(256) 739-4921
Mailing address
212 4TH AVE SE, SUITE 100, CULLMAN, AL 35055-3673
(256) 739-6050
(256) 739-4921
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9759
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035588
MEDICARE PTAN
—
05
—
000035588
—
AL
01
—
051035588
BLUE CROSS/BLUE SHIELD OF ALABAMA
—
Enumeration date
10/07/2008
Last updated
09/12/2016
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