Provider Demographics
NPI:1093825127
Name:MCCORVEY, ROOSEVELT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOSEVELT
Middle Name:
Last Name:MCCORVEY
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 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-273-4159
Mailing Address - Fax:334-273-4290
Practice Address - Street 1:2455 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4336
Practice Address - Country:US
Practice Address - Phone:334-747-8980
Practice Address - Fax:334-747-8970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.7451207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200816Medicaid
AL009933571Medicaid
AL6614160OtherCIGNA
AL102I68010OtherMEDICARE
AL200583Medicaid
AL511-94292OtherBCBS
AL511-94294OtherBCBS
AL202249Medicaid
AL511-94291OtherBCBS
ALP01873133OtherRAILROAD MEDICARE