Provider Demographics
NPI:1104843192
Name:GOOLSBY, RUPA D (MD)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:D
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-271-1600
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:NORTH TOWER SUITE 600
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-271-1600
Practice Address - Fax:205-271-3167
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16758207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030059Medicaid
AL000030059Medicaid
ALF81333Medicare UPIN