Provider Demographics
NPI:1558579375
Name:ALMODOVAR-RETEGUIS, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ALMODOVAR-RETEGUIS
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060347207U00000X
AL31018207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051120025OtherBCBS
ALZ21039OtherVIVA
AL051120021OtherBCBS
AL131213Medicaid
AL131215Medicaid
AL131226Medicaid
AL051120018OtherBCBS
AL051120026OtherBCBS
AL131220Medicaid
AL131224Medicaid
AL051120022OtherBCBS
MS09770524Medicaid
AL131219Medicaid
AL131222Medicaid
AL131228Medicaid
AL51120027OtherBCBS
AL051120019OtherBCBS
AL051120023OtherBCBS
AL051120024OtherBCBS
AL051120028OtherBCBS
AL131212Medicaid
AL131217Medicaid
AL51120027OtherBCBS