Provider Demographics
NPI:1376583005
Name:PHELPS, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:PHELPS
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 1:208 MCFARLAND CIR N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1800
Mailing Address - Country:US
Mailing Address - Phone:205-345-7000
Mailing Address - Fax:205-343-0910
Practice Address - Street 1:208 MCFARLAND CIR N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1800
Practice Address - Country:US
Practice Address - Phone:205-345-7000
Practice Address - Fax:205-343-0910
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009991260Medicaid
AL009991370Medicaid
AL000004984Medicaid
AL009991330Medicaid
AL009991250Medicaid
AL009991270Medicaid
AL009991290Medicaid
AL009991320Medicaid
AL009991360Medicaid
AL009991280Medicaid
AL009992470Medicaid
AL009991340Medicaid
AL009991350Medicaid
AL009991250Medicaid
AL009991290Medicaid
AL009991350Medicaid