Provider Demographics
NPI:1407850126
Name:ULRICH, RUSSELL DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DEAN
Last Name:ULRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-5893
Mailing Address - Country:US
Mailing Address - Phone:256-447-9045
Mailing Address - Fax:256-447-9040
Practice Address - Street 1:25 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5893
Practice Address - Country:US
Practice Address - Phone:256-447-9045
Practice Address - Fax:256-447-9040
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 47207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010742Medicaid
AL510-10742OtherBLUE CROSS
AL510-10742OtherBLUE CROSS
AL10742Medicare ID - Type Unspecified