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Organization

LAKESHORE PEDIATRICS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AGUSTIN G RIVAS MD (PRESIDENT)
(256) 386-4151
Entity
Organization

Contact information

Practice address
12521 AL HIGHWAY 157 STE B, MOULTON, AL 35650-1937
(256) 974-6300
(256) 974-6333
Mailing address
1120 S JACKSON HWY STE 304, SHEFFIELD, AL 35660-5773
(256) 386-4151
(256) 383-7293

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Enumeration date
06/12/2013
Last updated
06/12/2013
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