Provider Demographics
NPI:1609849488
Name:DEGUENTHER, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:DEGUENTHER
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 1:3485 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5603
Mailing Address - Country:US
Mailing Address - Phone:205-930-0920
Mailing Address - Fax:205-445-0115
Practice Address - Street 1:3485 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5603
Practice Address - Country:US
Practice Address - Phone:205-930-0920
Practice Address - Fax:205-445-0115
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018730208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2308260001OtherCIGNA
AL000025361Medicaid
ALE84894OtherVIVA
AL000025361OtherMEDICARE PTAN
AL1910105OtherUNITED HEALTHCARE
ALD815OtherMEDICARE GROUP PIN
ALE84894OtherHEALTH SPRINGS
AL0366100001OtherMC NSC
AL5375053OtherAETNA
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN