Provider Demographics
NPI:1013028828
Name:AG PODIATRIC SPECIALIST AND ASSOCIATES
Entity Type:Organization
Organization Name:AG PODIATRIC SPECIALIST AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-925-5272
Mailing Address - Street 1:1529 BESSEMER RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-4016
Mailing Address - Country:US
Mailing Address - Phone:205-925-5272
Mailing Address - Fax:205-925-5278
Practice Address - Street 1:1529 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4016
Practice Address - Country:US
Practice Address - Phone:205-925-5272
Practice Address - Fax:205-925-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL069765001OtherDEMERC PROVIDER NUMBER
ALP00105372OtherRAILROAD MEDICARE
AL000031102OtherEUFAULA PROVIDER
AL1013028828OtherORGANIZATIONAL NPI
AL2710019OtherUNITED HEALTH CARE
AL2710019OtherUNITED HEALTH CARE
AL069765001OtherDEMERC PROVIDER NUMBER
AL0697650002Medicare NSC
ALP00105372OtherRAILROAD MEDICARE