Provider Demographics
NPI:1043479124
Name:DULANTO, FELIX R (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:R
Last Name:DULANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530604
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35253-0604
Mailing Address - Country:US
Mailing Address - Phone:205-879-8294
Mailing Address - Fax:205-879-8259
Practice Address - Street 1:7625 OLD SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1739
Practice Address - Country:US
Practice Address - Phone:205-879-8294
Practice Address - Fax:205-879-8259
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29733208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131837Medicaid
AL131837Medicaid