Provider Demographics
NPI:1366456295
Name:DIVITTORIO, GINO (MD)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:DIVITTORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6701 AIRPORT BLVD STE A 101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6767
Mailing Address - Country:US
Mailing Address - Phone:251-633-8880
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3271
Practice Address - Country:US
Practice Address - Phone:251-660-5787
Practice Address - Fax:251-460-7923
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-08-25
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Provider Licenses
StateLicense IDTaxonomies
AL00009491207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000093050Medicaid
AL000093050Medicaid
C78841Medicare UPIN