Provider Demographics
NPI:1609020866
Name:CANTRELL, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CANTRELL
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2217 DECATUR HWY
Mailing Address - Street 2:SUITE 131
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2301
Mailing Address - Country:US
Mailing Address - Phone:205-418-1200
Mailing Address - Fax:205-418-1271
Practice Address - Street 1:2217 DECATUR HWY
Practice Address - Street 2:SUITE 131
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2301
Practice Address - Country:US
Practice Address - Phone:205-418-1200
Practice Address - Fax:205-418-1271
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2013-12-05
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Provider Licenses
StateLicense IDTaxonomies
ALDO1085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1609020866Medicaid
AL1215687OtherCAQH
AL51106462OtherBLUE CROSS BLUE SHEILD OF ALABAMA
AL1609020866Medicaid