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Individual

RICKY L FENNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

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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