Organization
KEITH G VANDERZYL JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH GRANT VANDERZYL JR. MD (PRESIDENT)
(334) 774-5501
Entity
Organization
Contact information
Practice address
218 HOSPITAL AVE, STE D, OZARK, AL 36360-2064
(334) 774-5501
(334) 445-9785
Mailing address
218 HOSPITAL AVE, STE D, OZARK, AL 36360-2064
(334) 774-5501
(334) 445-9785
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8612
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011034
BCBS
—
05
—
000011034
—
AL
01
—
0196890002
DMERC
AL
Enumeration date
08/17/2007
Last updated
06/05/2008
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