Individual
RICKY L FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
21526
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009947355
—
AL
01
—
051520885
BLUE CROSS
AL
01
—
P00101365
RAILROAD MEDICARE
AL
Enumeration date
06/15/2006
Last updated
07/21/2011
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