Organization
EASTERN SHORE INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD L. SNELLGROVE M.D, (PHYSICIAN)
(251) 990-1770
Entity
Organization
Contact information
Practice address
374 GREENO RD S, FAIRHOPE, AL 36532-1916
(251) 990-1770
(251) 990-1771
Mailing address
374 GREENO RD S, FAIRHOPE, AL 36532-1916
(251) 990-1770
(251) 990-1771
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00016922
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000038007
—
AL
01
—
25-10092
UNITED HEALTHCARE
AL
01
—
510-38007
BC/BS
AL
Enumeration date
01/13/2011
Last updated
02/21/2011
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