Individual
MRS. ELLEN VIRGINIA DRAGSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
68 MARCO DRIVE SE, DECATUR, AL 35603-0000
(256) 432-2007
(256) 432-2010
Mailing address
PO BOX 970, RUSSELLVILLE, AL 35653-0970
(256) 332-1631
(256) 332-4600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00020153
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51525668
BLUE CROSS BLUE SHIELD
—
05
—
630102047
—
AL
Enumeration date
07/05/2006
Last updated
12/04/2012
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