Provider Demographics
NPI:1518654110
Name:ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY MEDICAL PRACTICE OF MONTGOMERY, PLLC
Other - Org Name:ADVANCED UROLOGY OF MONTGOMERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-612-7890
Mailing Address - Street 1:4216 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2804
Mailing Address - Country:US
Mailing Address - Phone:334-612-7890
Mailing Address - Fax:
Practice Address - Street 1:4216 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2804
Practice Address - Country:US
Practice Address - Phone:334-612-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty