Provider Demographics
NPI:1629079918
Name:PHILLEY, RONALD E (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:PHILLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-933-8981
Mailing Address - Fax:205-930-0746
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 700
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-933-8981
Practice Address - Fax:205-930-0746
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-386363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7803747OtherAETNA
AL009937562Medicaid
AL51534896OtherBCBS
AL009937562Medicaid
Q27782Medicare UPIN