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Individual

LAUTREC WILSON RADCLIFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2609 VILLAGE PROFESSIONAL DR, SUITE 3, OPELIKA, AL 36801-5442
(334) 749-6523
(334) 742-0242
Mailing address
2609 VILLAGE PROFESSIONAL DR, SUITE 3, OPELIKA, AL 36801-5442
(334) 749-6523
(334) 742-0242

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14179
AL
207RN0300X
Nephrology Physician
Primary
14179
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1801801493
NPI
AL
01
51038111
BCBS LAFAYETTE
AL
01
51079111
BCBS DADEVILLE
AL
01
51079130
BCBS LANGDALE
AL
01
51079131
BCBS OPELIKA
AL
01
51079203
BCBS TUSKEGEE
AL
01
51520919
BCBS AUBURN
AL
05
528701590
AL
01
CC1726
RRMC
AL
Enumeration date
07/30/2006
Last updated
09/13/2011
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