Provider Demographics
NPI:1639352388
Name:RICHARD A. VALENTINE MD LLC
Entity Type:Organization
Organization Name:RICHARD A. VALENTINE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-297-4883
Mailing Address - Street 1:1615 21ST CT
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3727
Mailing Address - Country:US
Mailing Address - Phone:334-297-4883
Mailing Address - Fax:334-297-7937
Practice Address - Street 1:1615 21ST CT
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3727
Practice Address - Country:US
Practice Address - Phone:334-297-4883
Practice Address - Fax:334-297-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-13286OtherBCBSAL
ALC72871Medicare UPIN