Provider Demographics
NPI:1588622658
Name:RUTLEDGE, GUY LESLIE III (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:LESLIE
Last Name:RUTLEDGE
Suffix:III
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 86144
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-6144
Mailing Address - Country:US
Mailing Address - Phone:251-476-5050
Mailing Address - Fax:251-450-2770
Practice Address - Street 1:6144 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3143
Practice Address - Country:US
Practice Address - Phone:251-476-5050
Practice Address - Fax:251-450-2770
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007589207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051079344OtherBCBS
AL000079344Medicaid
MS00118991Medicaid
200028699OtherRAILROAD MEDICARE
AL000079344Medicare ID - Type Unspecified
AL000079344Medicaid
MS00118991Medicaid