Organization Name: | MED MD PLUS, LLC |
NPI Number: | 1346676632 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY BRUCE HANKINS (OWNER/MD) |
Mailing Address: | 12 Cropwell Dr Pell City |
State: | AL US |
Postal Code: | 351287552 |
Phone Number: | 2058140404 |
Fax Number: | 2058140407 |
NPI Enumeration Date: | 09/19/2013 |
NPI Last Update Date: | 09/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 17795 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |