Provider Demographics
NPI:1528021474
Name:ABDEL MOUTAGALY, RIZK M (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZK
Middle Name:M
Last Name:ABDEL MOUTAGALY
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653
Mailing Address - Country:US
Mailing Address - Phone:256-332-1175
Mailing Address - Fax:256-332-1171
Practice Address - Street 1:715 GANDY ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653
Practice Address - Country:US
Practice Address - Phone:256-332-1175
Practice Address - Fax:256-332-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22718208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51021621OtherBLUE CROSS BLUE SHIELD
AL000021621Medicaid
AL000021621Medicaid
000021621Medicare ID - Type Unspecified